Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2302 | WI |
NPI | 1275686834 |
---|---|
Provider Name | Dr. Michael Vincent Cirilli |
First Address | Minocqua, WI 54548-9014 |
Second Address | Minocqua, WI 54548-9014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38834900 | (05) | WI |