Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 81-321 | WI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036071277 | IL |
NPI | 1255359675 |
---|---|
Provider Name | Mark G Neerhof |
First Address | Kenosha, WI 53142-7884 |
Second Address | Kenosha, WI 53142-7884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G09468 | (02) |