Healthcare Provider Details

I. General information

NPI: 1861525032
Provider Name (Legal Business Name): MICHELLE LEE FACER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4956 BULLIS FARM RD
EAU CLAIRE WI
54701
US

IV. Provider business mailing address

4956 BULLIS FARM RD
EAU CLAIRE WI
54701
US

V. Phone/Fax

Practice location:
  • Phone: 715-831-3300
  • Fax: 715-831-7958
Mailing address:
  • Phone: 715-831-3300
  • Fax: 715-831-7958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number44656
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: