Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 40807 | WI |
NPI | 1447309786 |
---|---|
Provider Name | Mark H Hermanoff |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Wauwatosa, WI 53226-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32516900 | (05) | WI |
F73274 | (02) | WI |