Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 36253 | WI |
NPI | 1023123262 |
---|---|
Provider Name | Dr. Jon A Dankle |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Burlington, WI 53105-1828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32146600 | (05) | WI |
BD3277604 | DEA NUMBER (01) | |
G12090 | (02) |