Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-110180 | IL |
Y | 207YP0228X | Pediatric Otolaryngology | 49373 | WI |
NPI | 1003802166 |
---|---|
Provider Name | Dr. Cecille G Sulman |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 29/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-110180 | (05) | IL |
1003802166 | (05) | WI |
I58684 | (02) |