Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | 75611 | WI |
Y | 2084N0402X | Child Neurologist | 75611 | WI |
NPI | 1336567833 |
---|---|
Provider Name | Melisa Carrasco Mccaul |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-7704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 22/09/2021 |