Organization
WISCONSIN INSTITUTE OF PLASTIC SURGERY SC
Active
Other names
Wisconsin Oculoplastics SC
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY J JUSTUS (PRACTICE MANAGER)
(920) 965-1234
Entity
Organization
Contact information
Practice address
2700 E ENTERPRISE AVE STE A, APPLETON, WI 54913-7656
(920) 965-1234
(920) 965-1232
Mailing address
2200 DICKINSON RD STE 17B, DE PERE, WI 54115-4056
(920) 965-1234
(920) 965-1232
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
—
—
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3677500
—
WI
Enumeration date
01/09/2007
Last updated
10/21/2021
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