Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 51152 | WI |
N | 207QA0401X | Family Doctor - Addiction Medicine | 51152 | WI |
NPI | 1013098821 |
---|---|
Provider Name | Eric A Smiltneek |
First Address | Fond Du Lac, WI 54937-2999 |
Second Address | Fond Du Lac, WI 54937-2999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 23/11/2021 |