Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 24621-021 | WI |
NPI | 1003895467 |
---|---|
Provider Name | Dr. Robert P Sievert |
First Address | Greendale, WI 53129-2452 |
Second Address | Fort Atkinson, WI 53538-1960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30018200 | (05) | WI |
B56612 | (02) | WI |