Organization
THE DOC AT YOUR DOOR,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICIA M DEMERY M.D. (PRESIDENT)
(920) 277-9716
Entity
Organization
Contact information
Practice address
N9554 HIGHLINE RD, KAUKAUNA, WI 54130-8502
(920) 277-9716
(920) 766-6802
Mailing address
N9554 HIGHLINE RD, KAUKAUNA, WI 54130-8502
(920) 277-9716
(920) 766-6802
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
32560
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31750000
—
WI
01
—
WI1789
MEDICARE PTAN
WI
01
—
WI1790
MEDICARE PTAN
WI
Enumeration date
07/09/2010
Last updated
11/29/2010
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