Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3523 | WI |
NPI | 1487783817 |
---|---|
Provider Name | Dr. Michael Corr |
First Address | Viroqua, WI 54665-2222 |
Second Address | Viroqua, WI 54665-2222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |