Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 40823 | WI |
N | 207QS0010X | Family Doctor - Sports Medicine | 40823 | WI |
NPI | 1144214057 |
---|---|
Provider Name | Erik A Emaus |
First Address | Menasha, WI 54952-1165 |
Second Address | Neenah, WI 54956-2753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 30/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30090700 | (05) | WI |
E90507 | (02) |