Provider Demographics
NPI:1215283866
Name:EC LASER AND SURGERY INSTITUTE OF WI, LLC
Entity type:Organization
Organization Name:EC LASER AND SURGERY INSTITUTE OF WI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FLATTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-603-4955
Mailing Address - Street 1:800 N 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4754
Mailing Address - Country:US
Mailing Address - Phone:715-298-5500
Mailing Address - Fax:715-298-5506
Practice Address - Street 1:800 N 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4754
Practice Address - Country:US
Practice Address - Phone:715-261-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIW12972OtherPTAN