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Defatta Ent & Facial Plastic Surgery Sc

Defatta Ent & Facial Plastic Surgery Sc is a health care provider in Altoona, WI. In this page you will find its mailing address, practice location, phone number, specialty etc.

physician-icon Basic Information

Practice Location 1490 Rivers Edge Trail, Altoona, WI 54720-1495, US
Practice Location Phone715-828-2368
Practice Location Fax715-726-2087
Legal Business NameDEFATTA ENT & FACIAL PLASTIC SURGERY SC
NPI ?1346664059
Entity TypeOrganization
Enumeration Date ? Feb 17, 2014
Last Update Date ? May 5, 2014
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).

specialty-icon Specialties & Licenses of Defatta Ent & Facial Plastic Surgery Sc

SpecialtySpecializationLicenseLicense State
Specialist 55984-20Wisconsin
Clinic/CenterMedical Specialty 55984-20Wisconsin

legacy-id-icon Legacy Provider IDs of Defatta Ent & Facial Plastic Surgery Sc

Provider IdIssuer StateIssuer TypeIssuer
1790931707WisconsinOtherNPI PROVIDER
100016459WisconsinMedicaid
1578697520WisconsinOtherNPI

official-icon Authorized Official of Defatta Ent & Facial Plastic Surgery Sc

An authorized official is an appointed official with the legal authority to make changes and/or updates to the Defatta Ent & Facial Plastic Surgery Sc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).

Authorized Official Dr. Robert Joseph Defatta (MD, PH D, FACS)
Authorized Official Title/PositionOWNER
Authorized Official Phone Number715-828-2368