MEDICARE: DME ACADEMY WISCONSIN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1174452502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME ACADEMY WISCONSIN LLC

Provider Business Mailing Address
First Line	:	2441 BELLEVUE AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5615
Country	:	US
Telephone Number	:	445-200-3669
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 BELLEVUE AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5615
Country	:	US
Telephone Number	:	445-200-3669
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	DANIEL PANAGGIO
Credential	:
Telephone Number	:	445-200-3669

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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