Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RS0012X | Sleep Medicine | 72867-20 | WI |
N | 2080P0214X | Pediatric Pulmonologist | 0101265758 | VA |
NPI | 1417987736 |
---|---|
Provider Name | Joseph A Crisalli |
First Address | Madison, WI 53713-2334 |
Second Address | Fitchburg, WI 53713-3117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1417987736 | (05) | WI |