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General NPI Number Information
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NPI Number | 1811804974
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Entity Type | Organization
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Legal Business Name | JEFFOG MEDICAL WI SC
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 21675 E MORELAND BLVD
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City | WAUKESHA
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State | WI
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Zip | 53186-2010
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Country | US
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Telephone | 262-325-5603
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 E ENTERPRISE AVE STE 333
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City | APPLETON
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State | WI
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Zip | 54913-7889
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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 | OWNER
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Name | JEFFREY DAVID FOGLE
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Credential | MD
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Telephone | 877-340-1697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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