Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 42366 | WI |
NPI | 1124079975 |
---|---|
Provider Name | Dr. Marc H Gorelick |
First Address | Milwaukee, WI 53226-3518 |
Second Address | Milwaukee, WI 53226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33337000 | (05) | WI |
F29073 | (02) |