Provider Demographics
NPI:1942524780
Name:FACE AND SKIN LLC
Entity Type:Organization
Organization Name:FACE AND SKIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-885-5225
Mailing Address - Street 1:120 PARK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2132
Mailing Address - Country:US
Mailing Address - Phone:920-885-5225
Mailing Address - Fax:920-356-6419
Practice Address - Street 1:120 PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2132
Practice Address - Country:US
Practice Address - Phone:920-885-5225
Practice Address - Fax:920-356-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100010205Medicaid
WIWI1905Medicare PIN
WI100010205Medicaid