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General NPI Number Information
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NPI Number | 1871513119
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Entity Type | Organization
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Legal Business Name | ROBERT L. HAUSSERMAN, M.D.,S.C.
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2105 E ENTERPRISE AVE STE 112
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City | APPLETON
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State | WI
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Zip | 54913-7862
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Country | US
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Telephone | 920-731-3111
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Fax | 920-731-7133
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Provider Business Mailing Address
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Address Line | 2105 E ENTERPRISE AVE STE 112
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City | APPLETON
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State | WI
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Zip | 54913-7862
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Country | US
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Telephone | 920-731-3111
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Fax | 920-731-7133
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT L HAUSSERMAN
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Credential | M.D.
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Telephone | 920-731-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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