Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 915-025 | WI |
NPI | 1053381566 |
---|---|
Provider Name | Jill Migon |
First Address | Middleton, WI 53562-3485 |
Second Address | Middleton, WI 53562-3485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43241600 | (05) | WI |
V09284 | (02) | WI |