Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 30978 | IA |
Y | 208800000X | Urologist | 36747 | WI |
NPI | 1003807686 |
---|---|
Provider Name | Michael J Price |
First Address | Eau Claire, WI 54702-1510 |
Second Address | La Crosse, WI 54601-8806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E32670 | (02) |