Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 266123 | NY |
Y | 111NI0900X | Internist | 266123 | NY |
N | 207RC0200X | Critical Care Medicine | 266123 | NY |
N | 207RP1001X | Pulmonary Disease | 266123 | NY |
N | 207RS0012X | Sleep Medicine | 266123 | NY |
NPI | 1063764207 |
---|---|
Provider Name | Gilbert Antonio Jenouri |
First Address | Milwaukee, WI 53220-2059 |
Second Address | Milwaukee, WI 53220-2059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2012 |
Last Update Date | 12/10/2012 |