Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036111098 | IL |
NPI | 1003899196 |
---|---|
Provider Name | Dr. Thomas Danko |
First Address | Milwaukee, WI 53278-8866 |
Second Address | Rockford, IL 61104-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 27/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036111098 | (05) | IL |
I15532 | (02) | IL |