Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 35081822 | OH |
N | 207RP1001X | Pulmonary Disease | 35081822 | OH |
Y | 207RP1001X | Pulmonary Disease | 52240 | WI |
NPI | 1033190178 |
---|---|
Provider Name | Dany S. Abou Abdallah |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Eau Claire, WI 54703-5222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 15/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2400842 | (05) | OH |
290015277 | MEDICARE RAILROAD (01) | OH |
H78613 | (02) | OH |