Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 42436 | WI |
N | 2086S0102X | Surgical Critical Care | 48119 | MN |
N | 2086S0102X | Surgical Critical Care | 88834 | OH |
N | 2086S0102X | Surgical Critical Care | A87596 | CA |
Y | 2086S0127X | Trauma Surgeon | 42436 | WI |
NPI | 1356410898 |
---|---|
Provider Name | Dr. Panna Ashok Codner |
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 | 07/11/2006 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356410898 | (05) | WI |
34687900 | (05) | WI |
I43499 | (02) | MN |