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Organization

FOND DU LAC COUNTY DCP CASE MANAGEMENT

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. J R MUSUNURU M.D. (DIRECTOR, PSYCHIATRIST)
(920) 929-3500
Entity
Organization

Contact information

Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3500
(920) 929-3129
Mailing address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3500
(920) 929-3129

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
43072100
WI
Enumeration date
02/01/2007
Last updated
08/22/2020
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