Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 73405-21 | WI |
NPI | 1518495407 |
---|---|
Provider Name | Andre N Cernasov |
First Address | Milwaukee, WI 53233-1305 |
Second Address | Milwaukee, WI 53233-1305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 30/11/2021 |