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General NPI Number Information
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NPI Number | 1154474252
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Entity Type | Organization
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Legal Business Name | AGAPES ACUPUNCTURE, SC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 566 REDBIRD CIR
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City | DE PERE
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State | WI
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Zip | 54115-8796
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Country | US
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Telephone | 920-337-9100
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Fax | 920-337-9101
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Provider Business Mailing Address
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Address Line | 566 REDBIRD CIR
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City | DE PERE
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State | WI
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Zip | 54115-8796
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Country | US
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Telephone | 920-337-9100
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Fax | 920-337-9101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL ROBERT POLEY
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Credential | M.D.
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Telephone | 920-337-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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