Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 19111 | WI |
NPI | 1093789950 |
---|---|
Provider Name | Dr. Kathryn D. Iorio |
First Address | Waukesha, WI 53188-3417 |
Second Address | Waukesha, WI 53188-3417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31212800 | (05) | WI |
B53775 | (02) | WI |