Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036.126371 | IL |
N | 207Q00000X | Family Doctor | 125.054488 | IL |
Y | 207Q00000X | Family Doctor | 56001-020 | WI |
NPI | 1003072687 |
---|---|
Provider Name | Dr. Robert William Sedlacek |
First Address | Neenah, WI 54956-3070 |
Second Address | Merrill, WI 54452-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 27/05/2020 |