Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 708 | WI |
Y | 222Z00000X | Podiatrist | 708 | WI |
NPI | 1023009891 |
---|---|
Provider Name | Dr. Isaac J Trejo |
First Address | Greendale, WI 53129-2452 |
Second Address | Milwaukee, WI 53207-4410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 21/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43220700 | (05) | WI |
U55955 | (02) | WI |