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General NPI Number Information
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NPI Number | 1750385597
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Entity Type | Organization
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Legal Business Name | ANESTHESIA SERVICES OF THE FOX VALLEY SC
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 500 S OAKWOOD RD
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City | OSHKOSH
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State | WI
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Zip | 54904-7944
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Country | US
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Telephone | 920-236-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 50 PEARL AVE STE 203
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City | OSHKOSH
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State | WI
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Zip | 54901-4811
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Country | US
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Telephone | 920-426-2211
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Fax | 920-426-2231
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN M LESCHKE
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Credential | MD
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Telephone | 920-426-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 27019
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License Number State | WI
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