| NPI | 1770957813 |
|---|---|
| Doing Business As | MEDI WEIGHT LOSS DEPERE |
| Entity Type | Organization |
| Authorized Contact | HERBERT S COUSSONS Owner 920-338-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VB0002X Obstetrics & Gynecology, Bariatric Medicine (Licence: WI 43795) |
| Enumeration Date | 2015-11-29 |
| Last Update Date | 2015-11-29 |