Provider Demographics
NPI:1205535788
Name:MOUSE MEDICAL INC
Entity type:Organization
Organization Name:MOUSE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MENIGOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:815-304-4353
Mailing Address - Street 1:1230 LARRY POWER RD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-4494
Mailing Address - Country:US
Mailing Address - Phone:815-340-4353
Mailing Address - Fax:815-304-4615
Practice Address - Street 1:1230 LARRY POWER RD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-4494
Practice Address - Country:US
Practice Address - Phone:815-340-4353
Practice Address - Fax:815-304-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172P00000XOther Service ProvidersNaprapathGroup - Single Specialty