Organization
COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER E YAKOVLEV M.D. (PRESIDENT)
(920) 733-7230
Entity
Organization
Contact information
Practice address
100 THEDA CLARK MEDICAL PLZ, SUITE 252, NEENAH, WI 54956-2763
(920) 733-7230
(920) 729-0347
Mailing address
100 THEDA CLARK MEDICAL PLZ, SUITE 252, NEENAH, WI 54956-2763
(920) 733-7230
(920) 729-0347
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
36140-20
WI
208VP0014X
Interventional Pain Medicine Physician
Primary
36140-20
WI
332B00000X
Durable Medical Equipment & Medical Supplies
36140-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34086400
—
WI
Enumeration date
06/25/2012
Last updated
01/24/2013
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