Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 47153 | WI |
N | 208600000X | Surgeon | 47153 | WI |
Y | 2086S0129X | Vascular Surgeon | 47153 | WI |
NPI | 1063450229 |
---|---|
Provider Name | Dr. Peter John Rossi |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 01/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036107064 | (05) | IL |
1063450229 | (05) | WI |
I54344 | (02) | IL |