Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 58000956 | OH |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 51760 | WI |
NPI | 1356558464 |
---|---|
Provider Name | Dr. Michael Josef Slimack |
First Address | Kenosha, WI 53142-7845 |
Second Address | Kenosha, WI 53142-7845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 18/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37580900 | (05) | WI |