Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 65157 | WI |
NPI | 1063839397 |
---|---|
Provider Name | Elizabeth Ann Bukowy |
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 | 25/03/2014 |
Last Update Date | 15/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063839397 | (05) | WI |