Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 74763 | WI |
N | 207YP0228X | Pediatric Otolaryngology | 74763 | WI |
NPI | 1538521869 |
---|---|
Provider Name | Anna Bakeman |
First Address | Milwaukee, WI 53226-3462 |
Second Address | Milwaukee, WI 53226-3462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1538521869 | (05) | WI |