Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17972-875 | WI |
N | 1223P0700X | Prosthodontist | 27418 | TX |
NPI | 1063815975 |
---|---|
Provider Name | Dr. Georgios Maroulakos |
First Address | Milwaukee, WI 53233-2186 |
Second Address | Milwaukee, WI 53233-2186 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2014 |
Last Update Date | 26/07/2015 |