Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 65920-20 | WI |
NPI | 1366670770 |
---|---|
Provider Name | Dr. Martin J Dib |
First Address | Santiago, CHILI 7500000 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 01/10/2018 |