Provider Demographics
NPI:1861525032
Name:FACER, MICHELLE LEE (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:FACER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 BULLIS FARM RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-831-3300
Mailing Address - Fax:715-831-7958
Practice Address - Street 1:4956 BULLIS FARM RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-831-3300
Practice Address - Fax:715-831-7958
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44656207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00143300OtherRR MEDICARE
1000376OtherMEDICA
WI43498800Medicaid
HP60546OtherHEALTHPARTNERS
HP60546OtherHEALTHPARTNERS
HP60546OtherHEALTHPARTNERS
$$$$$$$$$999OtherANTHEM BCBS OF WI