Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 16735-020 | WI |
NPI | 1144464199 |
---|---|
Provider Name | Lyall Carlton Stilp II |
First Address | Oshkosh, WI 54903-2742 |
Second Address | Oshkosh, WI 54902-9121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 21/04/2009 |