Beaver Dam Ent LLC

NPI #1124277009 in Beaver Dam, Wisconsin

Provider Information

NPI Number: 1124277009
Entity Type: Organization
Organization Name: Beaver Dam Ent LLC
Primary Specialty: Otolaryngology
Enumeration Date: Sep 16, 2008
Last Updated: Jan 23, 2009

Practice Location

Address: 707 S UNIVERSITY AVE
City: Beaver Dam
State: Wisconsin
ZIP Code: 53916-3027
Phone: (920) 887-6383

Authorized Official

Name: K SCOTT ABRAMS, CPA
Title: CFO
Phone: (920) 887-4041

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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