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General NPI Number Information
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NPI Number | 1104138882
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Entity Type | Organization
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Legal Business Name | THE DOC AT YOUR DOOR,LLC
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | N9554 HIGHLINE RD
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City | KAUKAUNA
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State | WI
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Zip | 54130-8502
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Country | US
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Telephone | 920-277-9716
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Fax | 920-766-6802
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Provider Business Mailing Address
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Address Line | N9554 HIGHLINE RD
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City | KAUKAUNA
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State | WI
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Zip | 54130-8502
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Country | US
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Telephone | 920-277-9716
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Fax | 920-766-6802
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIA M DEMERY
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Credential | M.D.
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Telephone | 920-277-9716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 32560
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License Number State | WI
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