Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2388 | WI |
NPI | 1861442949 |
---|---|
Provider Name | Dr. Barry Micheal Radandt |
First Address | Pewaukee, WI 53072-5576 |
Second Address | Pewaukee, WI 53072-5576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38951900 | (05) | WI |
T86506 | (02) | WI |