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General NPI Number Information
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NPI Number | 1588110969
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Entity Type | Organization
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Legal Business Name | PREVEA CLINIC, INC.
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 2449 COUNTY HIGHWAY I
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-4410
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13008
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City | GREEN BAY
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State | WI
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Zip | 54307-3008
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. ASHOK RAI
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Credential | MD
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Telephone | 920-496-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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