Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 39164 | WI |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 39164 | WI |
NPI | 1629022546 |
---|---|
Provider Name | Dr. J Channing Tassone |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 25/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004000261T | HUMANA (01) | |
1629022546 | (05) | WI |
H56987 | (02) |