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General NPI Number Information
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NPI Number | 1619231263
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Entity Type | Organization
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Legal Business Name | PAUSTIAN MEDICAL & SURGICAL CENTER, S. C.
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | W3657 MAPLE RD
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City | NEILLSVILLE
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State | WI
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Zip | 54456-6065
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Country | US
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Telephone | 715-743-2483
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Fax | 715-743-7955
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Provider Business Mailing Address
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Address Line | W3657 MAPLE RD
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City | NEILLSVILLE
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State | WI
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Zip | 54456-6065
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Country | US
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Telephone | 715-743-2483
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Fax | 715-743-7956
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID LOWELL PAUSTIAN
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Credential | D.O.
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Telephone | 715-743-2483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 42083-21
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License Number State | WI
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