MEDICARE: FOX VALLEY UROLOGICAL ASSOCIATES SC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1356601587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX VALLEY UROLOGICAL ASSOCIATES SC

Provider Business Mailing Address
First Line	:	200 E WASHINGTON ST
Second Line	:	PO BOX 8031
City	:	APPLETON
State	:	WI
Zip	:	54911-5490
Country	:	US
Telephone Number	:	866-313-0337
Fax Number	:	920-739-0124

Provider Business Practice Location Address
First Line	:	2700 E ENTERPRISE AVE STE A
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7656
Country	:	US
Telephone Number	:	920-380-9890
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANK M. CHYBOWSKI
Credential	:	MD
Telephone Number	:	920-450-7510

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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