Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 33350 | WI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 33350 | WI |
NPI | 1215989579 |
---|---|
Provider Name | Dr. Craig C Young |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002000139I | HUMANA (01) | |
1215989579 | (05) | WI |
E49253 | (02) |