Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ML60019966 | WA |
Y | 2080P0210X | Pediatric Nephrologist | 62733-20 | WI |
NPI | 1194980938 |
---|---|
Provider Name | Dr. Aaron Gilman Wightman |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 11/08/2014 |