Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4000999-015 | WI |
NPI | 1013096387 |
---|---|
Provider Name | Dr. Bruno Elmer Schiffleger |
First Address | Elkhorn, WI 53121-4038 |
Second Address | Lake Geneva, WI 53147-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |