Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 2427-057 | WI |
NPI | 1427255678 |
---|---|
Provider Name | Dr. Michael John Orrico |
First Address | Lodi, WI 53555-9725 |
Second Address | Lodi, WI 53555-9725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |