Healthcare Provider Details

I. General information

NPI: 1376656959
Provider Name (Legal Business Name): THEDACARE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MILL ST
NEW LONDON WI
54961-2155
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-830-5900
  • Fax: 920-830-5910
Mailing address:
  • Phone: 920-454-4229
  • Fax: 920-993-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM FLETT
Title or Position: CFO
Credential:
Phone: 920-454-4013