Provider Demographics
NPI:1194009696
Name:GAROFALO, KEITH WILLIAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:WILLIAM
Last Name:GAROFALO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6939 MARINER DR
Mailing Address - Street 2:STE D
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4090
Mailing Address - Country:US
Mailing Address - Phone:262-822-4844
Mailing Address - Fax:
Practice Address - Street 1:6939 MARINER DR
Practice Address - Street 2:STE D
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4090
Practice Address - Country:US
Practice Address - Phone:262-822-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI732-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist