Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 72372 | WI |
N | 207RC0000X | Internist - Cardiovascular Disease | 72372 | WI |
NPI | 1396735049 |
---|---|
Provider Name | Dr. Jacob D Luthman |
First Address | Milwaukee, WI 53215-4330 |
Second Address | Milwaukee, WI 53215-4330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100095619 | (05) | WI |