Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1024-25 | WI |
Y | 222Z00000X | Podiatrist | 1024-25 | WI |
N | 213E00000X | Podiatrist | MK002134 | MI |
N | 222Z00000X | Podiatrist | MK002134 | MI |
NPI | 1003080102 |
---|---|
Provider Name | Mark Andrew Kachan |
First Address | Green Bay, WI 54313-7152 |
Second Address | Green Bay, WI 54313-7152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2008 |
Last Update Date | 07/06/2013 |