Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | WI |
NPI | 1073665626 |
---|---|
Provider Name | James A Cranberg |
First Address | Glendale, WI 53209-2133 |
Second Address | Wauwatosa, WI 53226-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31517400 | (05) | WI |
E47049 | (02) | WI |