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General NPI Number Information
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NPI Number | 1699964817
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Entity Type | Organization
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Legal Business Name | FRANK J ELMUDESI PSYD LTD
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 420 MADISON ST
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1709
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Country | US
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Telephone | 251-847-3094
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Fax |
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Provider Business Mailing Address
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Address Line | 420 MADISON ST
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1709
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Country | US
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Telephone | 251-847-3094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANK J ELMUDESI PSYD LTD
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Credential | PSYD
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Telephone | 251-847-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 39128400
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License Number State | WI
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