Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 54168 | WI |
N | 208000000X | Pediatrician | 54168 | WI |
N | 2080P0201X | Pediatric Allergist | 54168 | WI |
NPI | 1376707307 |
---|---|
Provider Name | Mark J Biagtan |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 14/01/2021 |