Individual
THOMAS RUFFALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 569-9119
Mailing address
541 S SAWYER RD, OCONOMOWOC, WI 53066-9243
(262) 244-7693
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
657-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42936300
—
WI
Enumeration date
09/15/2005
Last updated
07/08/2007
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