Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 22873 | WI |
NPI | 1114958394 |
---|---|
Provider Name | Joseph A. Bretza |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Milwaukee, WI 53209-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 30/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30342100 | (05) | WI |
A46573 | (02) | WI |
P00617893 | RR MEDICARE (01) | WI |