Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 45820 | WI |
NPI | 1033106877 |
---|---|
Provider Name | Dr. Pedro M. Banda |
First Address | Glendale, WI 53212-1082 |
Second Address | Milwaukee, WI 53211-4445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 07/06/2012 |