Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 01030418A | IN |
Y | 2086S0129X | Vascular Surgeon | 63607 | WI |
NPI | 1104803352 |
---|---|
Provider Name | Dr. John W Oren |
First Address | Mequon, WI 53092-5172 |
Second Address | Mequon, WI 53092-5172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 12/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C24537 | (02) | IN |
P00654399 | RR MEDICARE (01) | IN |