Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 73320-20 | WI |
N | 208600000X | Surgeon | 73320-20 | WI |
Y | 2086X0206X | Surgical Oncologist | 73320 | WI |
NPI | 1225418668 |
---|---|
Provider Name | Dr. Olivia Mallory Delozier |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2015 |
Last Update Date | 28/07/2020 |