Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 68721.20 | WI |
NPI | 1043674476 |
---|---|
Provider Name | Dr. Joshua Arehart |
First Address | West Allis, WI 53227-2142 |
Second Address | West Allis, WI 53227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2016 |
Last Update Date | 26/09/2018 |