Organization
WISCONSIN EATING DISORDER SPECIALISTS SC
Active
Organization
WISCONSIN EATING DISORDER SPECIALISTS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE WELTZIN MD (OWNER)
(262) 646-4411
Entity
Organization
Contact information
Practice address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-1387
(262) 646-7067
Mailing address
3630 N HICKORY LN, OCONOMOWOC, WI 53066-4532
(262) 646-1387
(262) 646-7067
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21282400
—
WI
Enumeration date
08/10/2006
Last updated
08/22/2020
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