Provider Demographics
NPI:1255450086
Name:FOX VALLEY PSYCHIATRIC ASSOCIATES
Entity type:Organization
Organization Name:FOX VALLEY PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-738-2700
Mailing Address - Street 1:1531 S MADISON ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-738-2700
Mailing Address - Fax:920-738-8051
Practice Address - Street 1:1531 S MADISON ST
Practice Address - Street 2:SUITE 550
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915
Practice Address - Country:US
Practice Address - Phone:920-738-2700
Practice Address - Fax:920-738-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty