Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1001970-15 | WI |
NPI | 1104210277 |
---|---|
Provider Name | Alexandra Claire Korte |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53216-1382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104210277 | (05) | WI |