Individual
DR. ROBERT A FASANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2248
Mailing address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2248
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-102882
IL
207R00000X
Internal Medicine Physician
38693-20
WI
208M00000X
Hospitalist Physician
Primary
38693-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770666471
—
WI
05
—
32332100
—
WI
01
—
FASANROB
MERCYCARE INSURANCE
WI
01
—
P00917285
RR MEDICARE
WI
Enumeration date
10/24/2006
Last updated
12/30/2024
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