Organization
CMWL
Active
Other names
Medi Weight Loss Depere
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HERBERT S COUSSONS MD (OWNER)
(920) 338-6868
Entity
Organization
Contact information
Practice address
801 MAIN AVE, DE PERE, WI 54115-1334
(920) 330-9033
Mailing address
2641 DEVELOPMENT DR, GREEN BAY, WI 54311-4240
(920) 338-6868
(920) 338-6869
Taxonomy
Speciality
Code
Description
License number
State
207VB0002X
Obesity Medicine (Obstetrics & Gynecology) Physician
Primary
43795
WI
Other
Enumeration date
11/29/2015
Last updated
11/29/2015
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