Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 30816-020 | WI |
N | 208200000X | Surgeon | 30816-020 | WI |
N | 208600000X | Surgeon | 30816-020 | WI |
N | 213E00000X | Podiatrist | 633-025 | WI |
N | 222Z00000X | Podiatrist | 633-025 | WI |
N | 213ES0131X | Foot Surgery | 633-025 | WI |
NPI | 1073506192 |
---|---|
Provider Name | John W Silkey |
First Address | Berlin, WI 54923-1243 |
Second Address | Berlin, WI 54923-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 01/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31558300 | (05) | WI |
F07706 | (02) | WI |