Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 24928 | WI |
NPI | 1326143942 |
---|---|
Provider Name | Dr. Jeffrey B Gorelick |
First Address | Wallwatosa, WI 53213 |
Second Address | Wallwatosa, WI 53213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B53165 | (02) |