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.
|Practice Location|| 1490 Rivers Edge Trail, Altoona, WI 54720-1495, US |
|Practice Location Phone||715-828-2368|
|Practice Location Fax||715-726-2087|
|Legal Business Name||DEFATTA ENT & FACIAL PLASTIC SURGERY SC|
|Enumeration Date ? ||Feb 17, 2014|
|Last Update Date ? ||May 5, 2014|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
Specialties & Licenses of Defatta Ent & Facial Plastic Surgery Sc
|Specialty||Provider Type||Specialization||License||License State|
|Specialist||Other Service Providers|| ||55984-20||Wisconsin|
|Clinic/Center||Ambulatory Health Care Facilities||Medical Specialty ||55984-20||Wisconsin|
Legacy Provider IDs of Defatta Ent & Facial Plastic Surgery Sc
|Provider Id||Issuer State||Issuer Type||Issuer|
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/Position||OWNER|
|Authorized Official Phone Number||715-828-2368|