Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 25448 | WI |
NPI | 1073596730 |
---|---|
Provider Name | Dr. Rom A Stevens |
First Address | Milwaukee, WI 53215-3660 |
Second Address | Milwaukee, WI 53215-3660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2005 |
Last Update Date | 05/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31779900 | (05) | WI |
C22265 | (02) |