Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 51334 | WI |
NPI | 1649329574 |
---|---|
Provider Name | Dr. Dominic O Co |
First Address | Madison, WI 53792-0001 |
Second Address | Madison, WI 53792-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 12/01/2021 |