Individual
WALTER J FAILLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
(608) 775-4467
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
(608) 775-4467
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
44329
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34292200
—
WI
Enumeration date
06/16/2005
Last updated
07/10/2008
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