Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 73175-20 | WI |
N | 208000000X | Pediatrician | C7000-3519 | DE |
N | 208000000X | Pediatrician | MD60085554 | WA |
N | 208000000X | Pediatrician | MT 189428 | PA |
NPI | 1003947649 |
---|---|
Provider Name | Benjamin Bruno Barsotti |
First Address | Wausau, WI 54401-3769 |
Second Address | Wausau, WI 54401-4187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 23/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0251413 | LABOR AND INDUSTRIES (01) | WA |
8543779 | (05) | WA |