Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 39603 | WI |
NPI | 1023084555 |
---|---|
Provider Name | Andrew T Thliveris |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 06/04/2021 |