Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 65960-20 | WI |
N | 208600000X | Surgeon | 65960-20 | WI |
Y | 2082S0105X | Plastic Hand Surgeon | 65960-20 | WI |
NPI | 1366677007 |
---|---|
Provider Name | Brett Foster Michelotti |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-5531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 25/01/2021 |