Provider Demographics
NPI:1295042711
Name:YOMEX LLC
Entity Type:Organization
Organization Name:YOMEX LLC
Other - Org Name:MILWAUKEE ADVANCED FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEXTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEACON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-326-9034
Mailing Address - Street 1:1626 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1228
Mailing Address - Country:US
Mailing Address - Phone:414-326-9034
Mailing Address - Fax:414-763-2305
Practice Address - Street 1:1626 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1228
Practice Address - Country:US
Practice Address - Phone:414-326-9034
Practice Address - Fax:414-763-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI949-25261QP1100X
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6501400001Medicare NSC