CMWL

Primary specialty

Obesity Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VB0002X

License

43795 Issued in WI

Legal business name

CMWL

Doing business as

Medi Weight Loss Depere

Practice address

801 Main Ave
De Pere, WI 54115-1334

Phone

(920) 330-9033

NPI assigned

Nov 29, 2015

Last updated

Nov 29, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Herbert S Coussons, MD

Title

Owner

Phone

(920) 338-6868

Specialties & licenses 1

Addresses

Other names 1

• Medi Weight Loss Depere Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448755200000",
    "number": "1770957813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2641 DEVELOPMENT DR",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543114240",
            "telephone_number": "920-338-6868",
            "fax_number": "920-338-6869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MAIN AVE",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151334",
            "telephone_number": "920-330-9033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMWL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-29",
        "last_updated": "2015-11-29",
        "status": "A",
        "authorized_official_last_name": "COUSSONS",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-338-6868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VB0002X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obesity Medicine",
            "state": "WI",
            "license": "43795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi Weight Loss Depere",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Obstetrics & Gynecology Physician in De Pere, WI
• Providers in De Pere, WI by specialty
• Obstetrics & Gynecology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.