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General NPI Number Information
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NPI Number | 1184841645
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Entity Type | Organization
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Legal Business Name | CITY OF OSHKOSH
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 CHURCH AVE
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City | OSHKOSH
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State | WI
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Zip | 54901-4747
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Country | US
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Telephone | 920-236-5030
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Fax | 920-236-5186
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Provider Business Mailing Address
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Address Line | 215 CHURCH AVE
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City | OSHKOSH
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State | WI
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Zip | 54901-4747
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Country | US
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Telephone | 920-236-5030
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Fax | 920-236-5186
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Authorized Official
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Title or Position | MEDICAL ADVISOR - IMMUNIZATION PROG
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Name | DR. ROBERT DEVERMANN
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Credential | M.D.
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Telephone | 920-236-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 35193
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License Number State | WI
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