Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 32960 | WI |
Y | 2084N0402X | Child Neurologist | 52772 | AZ |
N | 2084N0402X | Child Neurologist | ME118043 | FL |
NPI | 1194794792 |
---|---|
Provider Name | Christopher M Inglese |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000201235 | MEDICARE (01) | WI |
1194794792 | (05) | WI |
169888 | (05) | AZ |
B39612 | (02) | WI |
BI0909981 | DEA (01) | WI |
PENDING | (05) | FL |