Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 045676 | GA |
Y | 2086S0120X | Pediatric Surgery | 35.139193 | OH |
NPI | 1053409698 |
---|---|
Provider Name | Dr. Mark L. Wulkan |
First Address | Akron, OH 44308-1063 |
Second Address | Akron, OH 44308-1063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 16/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37BBFHJ | MEDICARE PTAN (01) | GA |
G09222 | (02) | GA |