Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 48342-020 | WI |
NPI | 1003835422 |
---|---|
Provider Name | Dr. Mark R Carey |
First Address | Waukesha, WI 53186-5990 |
Second Address | Waukesha, WI 53186-5990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34721400 | (05) | WI |
I49667 | (02) | WI |