| NPI | 1497810857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER E YAKOVLEV Owner/President 920-733-7230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 36140-20) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 36140-20) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WI 36140-20) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2013-01-24 |