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General NPI Number Information
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NPI Number | 1821376419
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Entity Type | Organization
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Legal Business Name | FOX VALLEY WELLNESS CENTER/MIDWEST HYPERBARICS
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 180 KNIGHTS WAY
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City | FOND DU LAC
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State | WI
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Zip | 54935-8027
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Country | US
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Telephone | 920-922-5433
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Fax | 920-273-0480
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Provider Business Mailing Address
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Address Line | 180 KNIGHTS WAY
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City | FOND DU LAC
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State | WI
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Zip | 54935-8027
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Country | US
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Telephone | 920-922-5433
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Fax | 920-273-0480
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN GREGORY MERESS
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Credential | M.D.
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Telephone | 920-922-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28559
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License Number State | WI
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