Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 474 | CT |
N | 213ES0131X | Foot Surgery | 474 | CT |
NPI | 1497817118 |
---|---|
Provider Name | Michael Connor |
First Address | Wilton, CT 06897-4405 |
Second Address | Wilton, CT 06897-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2006 |
Last Update Date | 10/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04091617 | (05) | CT |
T86140 | (02) | CT |