Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 28333 | WI |
NPI | 1003912346 |
---|---|
Provider Name | Dr. Richard V Colan |
First Address | Oak Creek, WI 53154-3760 |
Second Address | Oak Creek, WI 53154-3760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 03/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30831400 | (05) | WI |
B52144 | (02) | WI |