Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 62805 | WI |
NPI | 1063528867 |
---|---|
Provider Name | Dr. Sanjay Kumar |
First Address | Marshfield, WI 54449-5703 |
Second Address | Weston, WI 54476-5213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H29546 | (02) |