Organization
SPORTS MEDICINE CENTER S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETIENNE A MEJIA M.D. (PRESDIENT)
(920) 993-1643
Entity
Organization
Contact information
Practice address
277 ALTENHOFEN DR, APPLETON, WI 54913-8401
(920) 993-1643
(920) 993-1645
Mailing address
277 ALTENHOFEN DR, APPLETON, WI 54913-8401
(920) 993-1643
(920) 993-1645
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
07/27/2006
Last updated
01/20/2009
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