Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 664 | WI |
NPI | 1316156318 |
---|---|
Provider Name | Dr. Darcia Merritt Dillard |
First Address | Milwaukee, WI 53224-2586 |
Second Address | Milwaukee, WI 53224-2586 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43216700 | (05) | WI |
U37085 | (02) | WI |