Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301088584 | MI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 57224 | WI |
Y | 207YP0228X | Pediatric Otolaryngology | 57224 | WI |
NPI | 1528262839 |
---|---|
Provider Name | Dr. Michael Edward Mccormick |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1528262839 | (05) | WI |