Healthcare Provider Details

I. General information

NPI: 1528065257
Provider Name (Legal Business Name): JAMES EDWARD MEADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOSPITAL DR
WATERTOWN WI
53098-3304
US

IV. Provider business mailing address

134 HOSPITAL DR
WATERTOWN WI
53098-3304
US

V. Phone/Fax

Practice location:
  • Phone: 920-261-6500
  • Fax: 920-261-6107
Mailing address:
  • Phone: 920-261-6500
  • Fax: 920-261-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number33913
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: