Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 63801-21 | WI |
Y | 2080P0205X | Pediatric Endocrinologist | 63801 | WI |
NPI | 1326314170 |
---|---|
Provider Name | Dr. Samuel Patrick Engle |
First Address | Milwaukee, WI 53226-4875 |
Second Address | Milwaukee, WI 53226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 05/07/2018 |