Healthcare Provider Details

I. General information

NPI: 1528053469
Provider Name (Legal Business Name): THE CENTER FOR AESTHETICS & PLASTIC SURGERY S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S COMMERCIAL ST
NEENAH WI
54956-2526
US

IV. Provider business mailing address

425 S COMMERCIAL ST
NEENAH WI
54956-2526
US

V. Phone/Fax

Practice location:
  • Phone: 920-725-0700
  • Fax: 920-725-7978
Mailing address:
  • Phone: 920-725-0700
  • Fax: 920-725-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD M VAN YE
Title or Position: OWNER
Credential: MD
Phone: 920-725-0700