Provider Demographics
NPI:1770975930
Name:DAMIANI, FABRIZIO (LAC)
Entity type:Individual
Prefix:MR
First Name:FABRIZIO
Middle Name:
Last Name:DAMIANI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-8914
Mailing Address - Country:US
Mailing Address - Phone:608-322-8258
Mailing Address - Fax:
Practice Address - Street 1:412 PARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-8914
Practice Address - Country:US
Practice Address - Phone:608-322-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI844-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist