Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 17668 | WI |
NPI | 1104877620 |
---|---|
Provider Name | Dr. William F Prudlow |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30229700 | (05) | WI |
B55854 | (02) |