Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 21848 | WI |
Y | 207RA0201X | Internist - Allergy & Immunology | 21848 | WI |
NPI | 1225062524 |
---|---|
Provider Name | Brock V. Sherman |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Milwaukee, WI 53209-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30177400 | (05) | WI |
B56571 | (02) | WI |