Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 52556 | WI |
Y | 2084N0402X | Child Neurologist | 52556 | WI |
NPI | 1104063692 |
---|---|
Provider Name | Hrissanthi Ikonomidou |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2009 |
Last Update Date | 06/12/2021 |