Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 46620 | WI |
NPI | 1003875303 |
---|---|
Provider Name | Adam C Ankrum |
First Address | Milwaukee, WI 53202-4815 |
Second Address | Milwaukee, WI 53202-4815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114622715 | (05) | MI |
43515300 | (05) | WI |
I07801 | (02) | WI |
P00143665 | RAILROAD MEDICARE (01) | WI |