MEDICARE: DR. MEXTON M DEACON D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	949-25	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811185283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEXTON M DEACON D.P.M.

Provider Business Mailing Address
First Line	:	1626 W FOND DU LAC AVE
Second Line	:	STE 111
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1228
Country	:	US
Telephone Number	:	414-326-9034
Fax Number	:	414-763-2305

Provider Business Practice Location Address
First Line	:	1626 W FOND DU LAC AVE
Second Line	:	STE 111
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1228
Country	:	US
Telephone Number	:	414-326-9034
Fax Number	:	414-763-2305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	12/01/2020

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