Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 43479-020 | WI |
Y | 208600000X | Surgeon | 43479-020 | WI |
NPI | 1013982834 |
---|---|
Provider Name | Dr. Tracy E Mccall |
First Address | Waukesha, WI 53188-1170 |
Second Address | Waukesha, WI 53188-1170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 15/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201461107018 | BLUE CROSS AND BLUE SHIEL (01) | WI |
34144000 | (05) | WI |
H39851 | (02) | WI |