Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 33081-021 | WI |
NPI | 1043228141 |
---|---|
Provider Name | Dr. Christopher King |
First Address | Waukesha, WI 53188-3402 |
Second Address | Waukesha, WI 53188-3402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 02/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F338801 | (02) | WI |