Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2840 | WI |
NPI | 1043329741 |
---|---|
Provider Name | Dr. Daniel E Czelatdko |
First Address | Strum, WI 54770-5401 |
Second Address | Eau Claire, WI 54701-7757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38863400 | (05) | WI |
U31222 | (02) | WI |