Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 24997 | WI |
NPI | 1003882960 |
---|---|
Provider Name | Keith C Meyer |
First Address | Middleton, WI 53562-2349 |
Second Address | Middleton, WI 53562-2349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 26/02/2021 |