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General NPI Number Information
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NPI Number | 1720031214
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Entity Type | Organization
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Legal Business Name | DECESARE ORTHOPEDIC CLINIC SC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3213 STEIN BLVD
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-839-8399
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Fax | 715-839-9953
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Provider Business Mailing Address
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Address Line | 3213 STEIN BLVD
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-839-8399
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Fax | 715-839-9953
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Authorized Official
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Title or Position | CEO
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Name | WILLIAM F DECESARE
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Credential | MD
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Telephone | 715-839-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 20727020
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License Number State | WI
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