Organization
BOUC FAMILY WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY T BOUC M.D. (PHYSICIAN)
(608) 365-7200
Entity
Organization
Contact information
Practice address
3005 RIVERSIDE DR, SUITE 101, BELOIT, WI 53511-1500
(608) 365-7200
(608) 365-7202
Mailing address
3005 RIVERSIDE DR, SUITE 101, BELOIT, WI 53511-1500
(608) 365-7200
(608) 365-7202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36893
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32161500
—
WI
Enumeration date
10/24/2007
Last updated
04/26/2018
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