Organization
LIFE SKILLS SUPPORT CENTER OF EAU CLAIRE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NINO A VIDIC MD (OWNER)
(505) 730-2947
Entity
Organization
Contact information
Practice address
4907 KEYSTONE XING, EAU CLAIRE, WI 54701-5144
(505) 730-2947
Mailing address
4907 KEYSTONE XING, EAU CLAIRE, WI 54701-5144
(715) 514-0340
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50281-020
STATE LICENSE
WI
Enumeration date
06/29/2007
Last updated
07/18/2007
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