Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | IL | |
N | 222Z00000X | Podiatrist | IL | |
Y | 213E00000X | Podiatrist | 527 | WI |
Y | 222Z00000X | Podiatrist | 527 | WI |
NPI | 1053472076 |
---|---|
Provider Name | Mark E Pfeifer |
First Address | Lake Geneva, WI 53147-2655 |
Second Address | Lake Geneva, WI 53147-2655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43203100 | (05) | WI |
T62999 | (02) |