Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 37441 | WI |
N | 2086S0129X | Vascular Surgeon | 01057482A | IN |
NPI | 1023010659 |
---|---|
Provider Name | Manju Goel |
First Address | Richland Center, WI 53581-1900 |
Second Address | Richland Center, WI 53581-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32221600 | (05) | WI |
G27265 | (02) |