Individual
ROBERT LEO DESJARDIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1818 N MEADE ST, SUITE 240 WEST, APPLETON, WI 54911-3454
(920) 731-8289
(920) 832-0444
Mailing address
1818 N MEADE ST, SUITE 240 WEST, APPLETON, WI 54911-3454
(920) 731-8289
(920) 832-0444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
49 023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42901200
—
WI
Enumeration date
08/15/2005
Last updated
07/08/2007
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