Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1001006-15 | WI |
NPI | 1043612328 |
---|---|
Provider Name | Dr. Ami Inoue |
First Address | West Milwaukee, WI 53219-1641 |
Second Address | West Milwaukee, WI 53219-1641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 25/09/2019 |