Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2663-15 | WI |
N | 1223X0400X | Orthodontists | 7089 | IA |
NPI | 1033304704 |
---|---|
Provider Name | Michael W Barba |
First Address | La Crosse, WI 54601-5429 |
Second Address | Onalaska, WI 54650-8656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 28/04/2016 |