Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 21910-3541 | WI |
NPI | 1730239393 |
---|---|
Provider Name | Dr. John E Basich |
First Address | Greenfield, WI 53220-4364 |
Second Address | Greenfield, WI 53220-4364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30311400 | (05) | WI |
B15402 | (02) | WI |