Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 61545 | WY |
NPI | 1790081313 |
---|---|
Provider Name | Dr. Maria Kilari |
First Address | Greenfield, WI 53220-4361 |
Second Address | Greenfield, WI 53220-4361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2011 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1790081313 | (05) | WI |