Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5578015 | WI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 48605 | WI |
NPI | 1528173234 |
---|---|
Provider Name | Dr. Michael Scott Connor |
First Address | Waukesha, WI 53188-3417 |
Second Address | Waukesha, WI 53188-3417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 13/01/2011 |