Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 18065 | WI |
NPI | 1033177621 |
---|---|
Provider Name | John D Wegenke |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 10/04/2009 |