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General NPI Number Information
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NPI Number | 1629916192
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Entity Type | Organization
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Legal Business Name | ELITE MALE T CLINIC, LLC DBA ELITE HORMONES
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/24/2026
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Provider Practice Location Address
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Address Line | 505 S 24TH AVE STE 204
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City | WAUSAU
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State | WI
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Zip | 54401-1706
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Country | US
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Telephone | 715-240-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 3164 SHADY LN
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City | STEVENS POINT
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State | WI
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Zip | 54481-9508
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Country | US
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Telephone | 715-370-0380
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNE IVASKA
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Credential | APNP
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Telephone | 715-370-0380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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