Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 36870 | WI |
Y | 207PE0004X | Emergency Medical Services | 36870 | WI |
NPI | 1194725879 |
---|---|
Provider Name | Cyril Walsh |
First Address | Milwaukee, WI 53288-0001 |
Second Address | Appleton, WI 54911-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 20/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32163500 | (05) | WI |
G17382 | (02) | WI |