Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 42260-020 | WI |
NPI | 1063477941 |
---|---|
Provider Name | Dr. John J Meidl |
First Address | Milwaukee, WI 53215-3669 |
Second Address | Milwaukee, WI 53215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32645600 | (05) | WI |
440003173 | RAILROAD MEDICARE (01) | |
F10807 | (02) |