Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 46275-020 | WI |
NPI | 1033296520 |
---|---|
Provider Name | Dr. Eric Jon Lawatsch |
First Address | Neenah, WI 54956-1405 |
Second Address | Neenah, WI 54956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 18/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033296520 | (05) | WI |
I73340 | (02) | WI |