Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 43816 | MN |
N | 207K00000X | Allergist & Immunologist | 48074 | WI |
N | 207R00000X | Internist | 48074 | WI |
N | 111NI0900X | Internist | 48074 | WI |
Y | 207RA0201X | Internist - Allergy & Immunology | 48074 | WI |
NPI | 1063529170 |
---|---|
Provider Name | Dr. Abhilash R Vaishnav |
First Address | Milwaukee, WI 53215-2843 |
Second Address | De Pere, WI 54115-3770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34641800 | (05) | WI |