Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 36700 | WI |
NPI | 1053302729 |
---|---|
Provider Name | Michael Mullane |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Racine, WI 53406-5661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32142700 | (05) | WI |
F52179 | (02) |