Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 8109-851 | WI |
NPI | 1003378928 |
---|---|
Provider Name | Aidan James Reid |
First Address | Milwaukee, WI 53226-3548 |
Second Address | Milwaukee, WI 53226-3548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 26/11/2019 |