Defatta Ent & Facial Plastic Surgery Sc

NPI #1346664059 in Altoona, Wisconsin

Provider Information

NPI Number: 1346664059
Entity Type: Organization
Organization Name: Defatta Ent & Facial Plastic Surgery Sc
Primary Specialty: Specialist
Enumeration Date: Feb 17, 2014
Last Updated: May 5, 2014

Practice Location

Address: 1490 RIVERS EDGE TRAIL
City: Altoona
State: Wisconsin
ZIP Code: 54720-1495
Phone: (715) 828-2368

Authorized Official

Name: DR. ROBERT JOSEPH DEFATTA, MD, PH D, FACS
Title: OWNER
Phone: (715) 828-2368

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Medical Specialty — Medical Specialty	261QM2500X
Specialist	174400000X	Primary

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