Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 29304-020 | WI |
NPI | 1003878893 |
---|---|
Provider Name | Dr. Elma O Sia |
First Address | Madison, WI 53705-4901 |
Second Address | Madison, WI 53705-4901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31435000 | (05) | WI |
B56597 | (02) | WI |