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Defatta Ent & Facial Plastic Surgery Sc
Medical Specialty Clinic/Center in Altoona, Wisconsin
NPI 1346664059

Defatta Ent & Facial Plastic Surgery Sc is a Medical Specialty Clinic/Center based in Altoona, WI and is specialized in Medical Specialty. Defatta Ent & Facial Plastic Surgery Sc practices in Altoona, WI. The NPI Number for Defatta Ent & Facial Plastic Surgery Sc is 1346664059 and holds a License No. 55984-20 (Wisconsin).

The current practice location address for Defatta Ent & Facial Plastic Surgery Sc is 1490 Rivers Edge Trail, Altoona, WI and can be reached out via phone at 715-828-2368 and via fax at 715-726-2087.

Location: 1490 Rivers Edge Trail, Altoona, WI, 54720-1495
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1346664059
Provider Name
Defatta Ent & Facial Plastic Surgery Sc
Credential
Provider Entity Type
Organization
Address
1490 Rivers Edge Trail, Altoona, WI, 54720-1495
Phone Number
715-828-2368
Fax Number
715-726-2087
Provider Enumeration Date
02/17/2014
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1578697520 01 WI NPI
100016459 05 WI
1790931707 01 WI NPI PROVIDER
institution
Provider Business Practice Location Address Details
Address
1490 Rivers Edge Trail
City
Altoona
State
Wisconsin
Zip
54720-1495
Phone Number
715-828-2368
Fax Number
715-726-2087
person
Provider Business Mailing Address Details
Address
1490 Rivers Edge Trail
City
Altoona
State
Wisconsin
Zip
54720-1495
Phone Number
715-828-2368
Fax Number
715-726-2087
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
55984-20 (Wisconsin)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
55984-20 (Wisconsin)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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