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General NPI Number Information
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NPI Number | 1053389544
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Entity Type | Organization
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Legal Business Name | WATERTOWER PAIN CONSULTANTS, SC
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 575 W RIVER WOODS PKWY #205
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City | GLENDALE
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State | WI
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Zip | 53212-1003
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Country | US
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Telephone | 414-962-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 575 W RIVER WOODS PKWY #205
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City | GLENDALE
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State | WI
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Zip | 53212-1003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN DONATELLO
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Credential | MD
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Telephone | 414-962-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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