Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 59907-20 | WI |
NPI | 1083908677 |
---|---|
Provider Name | Dr. Jason Henry Przybylo |
First Address | Mount Pleasant, WI 53405-1644 |
Second Address | Mount Pleasant, WI 53405-1644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 13/09/2017 |