Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 43500 020 | WI |
N | 208600000X | Surgeon | 43500 020 | WI |
N | 2086X0206X | Surgical Oncologist | 43500 020 | WI |
NPI | 1285626465 |
---|---|
Provider Name | Charles C Cheng |
First Address | Appleton, WI 54911-3454 |
Second Address | Appleton, WI 54911-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34128600 | (05) | WI |
H40467 | (02) |