Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 54120-020 | WI |
N | 207ND0101X | MOHS-Micrographic Surgeon | 54120-020 | WI |
NPI | 1487773206 |
---|---|
Provider Name | Dr. John Starling III |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Milwaukee, WI 53226-1328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 24/02/2021 |