Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125060590 | IL |
N | 111NI0900X | Internist | 125060590 | IL |
N | 207SG0201X | Clinical Genetics (M.D.) | 69347 | WI |
N | 208000000X | Pediatrician | 125060590 | IL |
Y | 208000000X | Pediatrician | 69347 | WI |
NPI | 1740577634 |
---|---|
Provider Name | Michael Muriello |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2011 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1740577634 | (05) | WI |