Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 19614 | WI |
Y | 207VG0400X | Gynecologist | 19614 | WI |
NPI | 1083680151 |
---|---|
Provider Name | Klaus D Diem |
First Address | Verona, WI 53593-7931 |
Second Address | Verona, WI 53593-7931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 26/04/2018 |