Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 562-025 | WI |
Y | 222Z00000X | Podiatrist | 562-025 | WI |
NPI | 1053419317 |
---|---|
Provider Name | David John Labadie |
First Address | Greenfield, WI 53220-2046 |
Second Address | Greenfield, WI 53220-2046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 21/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43232900 | (05) | WI |
T61884 | (02) | WI |