Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 24295 | WI |
NPI | 1649484205 |
---|---|
Provider Name | Dr. Charles J Engel |
First Address | Waukesha, WI 53188 |
Second Address | Waukesha, WI 53188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30431300 | (05) | WI |
B52634 | (02) |