Organization
CITY OF BURLINGTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN J DEQUAKER (FINANCE DIRECTOR TREASURER)
(262) 342-1170
Entity
Organization
Contact information
Practice address
165 W WASHINGTON ST, BURLINGTON, WI 53105-1445
(262) 763-7842
(262) 767-8602
Mailing address
300 N PINE ST, BURLINGTON, WI 53105-1435
(262) 342-1170
(262) 767-9025
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6604945
STATE LICENSE PROVIDER NUMBER
WI
Enumeration date
08/15/2019
Last updated
08/15/2019
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