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General NPI Number Information
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NPI Number | 1215283866
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Entity Type | Organization
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Legal Business Name | EC LASER AND SURGERY INSTITUTE OF WI, LLC
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 800 N 1ST ST SUITE 100
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City | WAUSAU
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State | WI
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Zip | 54403-4754
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Country | US
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Telephone | 715-261-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 800 N 1ST ST SUITE 100
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City | WAUSAU
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State | WI
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Zip | 54403-4754
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Country | US
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Telephone | 715-298-5500
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Fax | 715-298-5506
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN ALEXANDER FLATTER
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Credential | MD
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Telephone | 209-603-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | WI
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