Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20827 | WI |
NPI | 1003842402 |
---|---|
Provider Name | Dr. Thomas A Lingen |
First Address | Cumberland, WI 54829-9187 |
Second Address | Cumberland, WI 54829-9187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 28/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30124600 | (05) | WI |
B54606 | (02) |