Provider Demographics
NPI:1144944349
Name:REPOSE PLLC
Entity type:Organization
Organization Name:REPOSE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-356-6416
Mailing Address - Street 1:120 PARK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-2132
Mailing Address - Country:US
Mailing Address - Phone:920-885-5225
Mailing Address - Fax:920-356-6419
Practice Address - Street 1:36539 HARPER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2012
Practice Address - Country:US
Practice Address - Phone:586-228-0600
Practice Address - Fax:920-356-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty