Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 12695 | WI |
NPI | 1053484683 |
---|---|
Provider Name | Dr. Alexander Joseph Macgillis |
First Address | Milwaukee, WI 53295-0001 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12695 | LICENSE NUMBER (01) | WI |