Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 044456 | CT |
N | 208600000X | Surgeon | 044456 | CT |
Y | 2086X0206X | Surgical Oncologist | 50679 | WI |
NPI | 1316141955 |
---|---|
Provider Name | Dr. Tracy Wang |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 18/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316141955 | (05) | WI |