Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 55219020 | WI |
Y | 208600000X | Surgeon | 55219020 | WI |
N | 2082S0105X | Plastic Hand Surgeon | 55219020 | WI |
NPI | 1528105897 |
---|---|
Provider Name | Alex Colque |
First Address | Waukesha, WI 53186-2906 |
Second Address | Waukesha, WI 53186-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 10/01/2014 |