Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 44105 | WI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 44105 | WI |
NPI | 1083714240 |
---|---|
Provider Name | Kathy Jo Williams |
First Address | Troy, MI 48099-1239 |
Second Address | Madison, WI 53718-7937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34272200 | (05) | WI |