Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 1002538 | WI |
Y | 213EG0000X | General Practice | 1002538 | WI |
NPI | 1003481953 |
---|---|
Provider Name | Dr. Ali Radmanesh |
First Address | Franklin, WI 53132-8045 |
Second Address | Franklin, WI 53132-8045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2021 |
Last Update Date | 17/06/2021 |