Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101058188 | VA |
Y | 207P00000X | Emergency Physician | 53510 | WI |
N | 207PP0204X | Pediatric Emergency Physician | 53510 | WI |
NPI | 1366407272 |
---|---|
Provider Name | Dr. Daniel Mielnicki |
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 | 20/04/2006 |
Last Update Date | 02/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366407272 | (05) | VA |
1366407272 | (05) | WI |