Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 60546-20 | WI |
NPI | 1073566030 |
---|---|
Provider Name | Dr. Alexander Spencer Tretinyak |
First Address | Appleton, WI 54911-3454 |
Second Address | Appleton, WI 54911-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 16/07/2013 |