Healthcare Provider Details

I. General information

NPI: 1104088202
Provider Name (Legal Business Name): PATRICK SAFO MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 ILLINOIS AVE
STEVENS POINT WI
54481-3112
US

IV. Provider business mailing address

211 SIOUX POINT RD STE 200
DAKOTA DUNES SD
57049-5492
US

V. Phone/Fax

Practice location:
  • Phone: 715-342-7500
  • Fax:
Mailing address:
  • Phone: 605-422-3000
  • Fax: 605-422-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number56518-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: