Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 45546 020 | WI |
NPI | 1194721407 |
---|---|
Provider Name | Dr. Nguyen H Phan |
First Address | Milwaukee, WI 53211-4528 |
Second Address | Milwaukee, WI 53211-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 24/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34379700 | (05) | WI |
G87119 | (02) | WI |