Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 39000 | KY |
NPI | 1093707689 |
---|---|
Provider Name | Dr. Louis A Suarez |
First Address | Green Bay, WI 54307-9070 |
Second Address | Green Bay, WI 54301-3526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64091705 | (05) | KY |
B85293 | (02) | KY |