Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 42813 | WI |
Y | 207K00000X | Allergist & Immunologist | 42813-02 | WI |
NPI | 1114999638 |
---|---|
Provider Name | Melissa L Chudnow |
First Address | Milwaukee, WI 53222-4404 |
Second Address | Milwaukee, WI 53222-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 03/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34199100 | (05) | WI |
H55902 | (02) | WI |
H66902 | (02) |