Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036132018 | IL |
N | 208000000X | Pediatrician | 65875 | WI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 65875 | WI |
NPI | 1063737013 |
---|---|
Provider Name | Dr. Larisa Broglie |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2010 |
Last Update Date | 22/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063737013 | (05) | WI |