Provider Demographics
NPI:1467522557
Name:LIFECARE PRACTITIONERS INC
Entity Type:Organization
Organization Name:LIFECARE PRACTITIONERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TREPANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-929-8120
Mailing Address - Street 1:481 E DIVISION ST
Mailing Address - Street 2:100
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3748
Mailing Address - Country:US
Mailing Address - Phone:920-929-8120
Mailing Address - Fax:920-929-8126
Practice Address - Street 1:481 E DIVISION ST
Practice Address - Street 2:100
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3748
Practice Address - Country:US
Practice Address - Phone:920-929-8120
Practice Address - Fax:920-929-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16852171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI207Q00000XOtherPROVIDER TAXONOMY CODE
WI207Q00000XOtherPROVIDER TAXONOMY CODE