Organization
WATERTOWER PAIN CONSULTANTS, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN DONATELLO MD (PRESIDENT)
(414) 962-6700
Entity
Organization
Contact information
Practice address
575 W RIVER WOODS PKWY, #205, GLENDALE, WI 53212-1003
(414) 962-6700
Mailing address
575 W RIVER WOODS PKWY, #205, GLENDALE, WI 53212-1003
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21298700
—
WI
01
—
52D1088766
CLIA
—
Enumeration date
03/09/2006
Last updated
10/09/2008
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