Provider Demographics
NPI:1023555349
Name:MIKE MESKE ACUPUNCTURE AND WELLNESS
Entity Type:Organization
Organization Name:MIKE MESKE ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MESKE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:262-352-3406
Mailing Address - Street 1:235 E PITTSBURGH AVE
Mailing Address - Street 2:401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-4312
Mailing Address - Country:US
Mailing Address - Phone:262-352-3406
Mailing Address - Fax:262-377-2388
Practice Address - Street 1:1664 7TH AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2333
Practice Address - Country:US
Practice Address - Phone:262-377-2400
Practice Address - Fax:262-377-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI842-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty