Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 46202 | WI |
NPI | 1114005642 |
---|---|
Provider Name | Ahmet U. Demircioglu |
First Address | South Milwaukee, WI 53172-1160 |
Second Address | St Francis, WI 53235-6055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 30/11/2021 |