Provider Demographics
NPI:1710936588
Name:FASSBINDER, KATIE R (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:R
Last Name:FASSBINDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 AIRPORT RD
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-1159
Mailing Address - Country:US
Mailing Address - Phone:608-638-7420
Mailing Address - Fax:608-638-7429
Practice Address - Street 1:210 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1159
Practice Address - Country:US
Practice Address - Phone:608-638-7420
Practice Address - Fax:608-638-7429
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1343-TEP2084P0800X
WI49741390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program