Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 45463-020 | WI |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 45463-20 | WI |
NPI | 1255378014 |
---|---|
Provider Name | Matthew S Bliss |
First Address | Fort Atkinson, WI 53538-0249 |
Second Address | Fort Atkinson, WI 53538-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 13/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34405300 | (05) | WI |
60102 | DEAN HEALTH INSURANCE (01) | WI |
H64316 | (02) |