Organization Name: | WISCONSIN VEIN CENTER AND MEDISPA, SC |
NPI Number: | 1083732788 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBORAH L MANJONEY (OWNER) |
Mailing Address: | 1231 George Towne Drive Suite G Pewaukee |
State: | WI US |
Postal Code: | 53072 |
Phone Number: | 2627469088 |
Fax Number: | 2627469088 |
NPI Enumeration Date: | 03/27/2007 |
NPI Last Update Date: | 10/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2086S0129X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Surgery |
Taxonomy Specialization: | Vascular Surgery |
Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |