Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 50845-020 | WI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 50845-020 | WI |
NPI | 1164699666 |
---|---|
Provider Name | Dr. Reginald Sy Cosiquien |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Eau Claire, WI 54701-6101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 14/09/2020 |