Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036143509 | IL |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 73455 | WI |
N | 207RC0000X | Internist - Cardiovascular Disease | 24648 | NE |
N | 207RC0000X | Internist - Cardiovascular Disease | 73455 | WI |
NPI | 1700907540 |
---|---|
Provider Name | Evgenia Raichlin |
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 | 02/04/2007 |
Last Update Date | 20/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1700907540 | (05) | WI |