Organization
PAIN CLINIC OF NORTHWESTERN WISCONSIN SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN MATHIAS ENDRES (AUTHORIZED REPRESENTATIVE)
(715) 552-5346
Entity
Organization
Contact information
Practice address
1221 WHIPPLE ST, EAU CLAIRE, WI 54703-5270
(715) 552-5346
(715) 838-6596
Mailing address
PO BOX 1185, EAU CLAIRE, WI 54702-1185
(715) 552-5346
(715) 838-6596
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32805000
—
WI
Enumeration date
03/10/2006
Last updated
11/21/2018
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