Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 34045 | WI |
NPI | 1023070364 |
---|---|
Provider Name | Dr. Louie Coulis |
First Address | Sheboygan, WI 53081-1988 |
Second Address | Sheboygan, WI 53081-1988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21290500 | (05) | WI |
31915100 | (05) | WI |
D95720 | (02) | WI |