Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 60315 | MN |
N | 208600000X | Surgeon | 60315 | MN |
N | 208200000X | Surgeon | 72516 | WI |
N | 208600000X | Surgeon | 72516 | WI |
N | 2086X0206X | Surgical Oncologist | 60315 | MN |
Y | 2086X0206X | Surgical Oncologist | 72516 | WI |
NPI | 1053864405 |
---|---|
Provider Name | Jennifer Racz |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2016 |
Last Update Date | 26/01/2021 |