Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5001194 | WI |
NPI | 1225054265 |
---|---|
Provider Name | Kenneth Peter Sobczak |
First Address | New Berlin, WI 53151-2396 |
Second Address | Milwaukee, WI 53295-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |