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Organization
THEDACARE, INCORPORATED
Active
Organization
THEDACARE, INCORPORATED
Active
Other names
THEDACARE PHYSICIANS PEDIATRICS
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM FLETT (CFO)
(920) 454-4013
Entity
Organization
Contact information
Practice address
2701 E ENTERPRISE AVE, APPLETON, WI 54913-7729
(920) 954-2551
(920) 954-2554
Mailing address
2701 E ENTERPRISE AVE, APPLETON, WI 54913-7729
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
40901020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32566400
—
WI
01
—
5127178
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/23/2006
Last updated
01/02/2024
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