Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4934 | WI |
NPI | 1023410123 |
---|---|
Provider Name | Lee S Bialkowski |
First Address | Green Bay, WI 54301-2878 |
Second Address | Green Bay, WI 54301-2878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 19/09/2014 |