Individual
MIKE PRODOEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
760 W JOHNSON ST, FOND DU LAC, WI 54935-2016
(920) 929-7422
Mailing address
760 W JOHNSON ST, FOND DU LAC, WI 54935-2016
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
16103-40
WI
Other
Enumeration date
02/15/2015
Last updated
02/15/2015
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