Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5000545-015 | WI |
N | 204E00000X | Oral & Maxillofacial Surgeon | 5000545-015 | WI |
NPI | 1295782555 |
---|---|
Provider Name | Michael W. Mcfarlane |
First Address | Oshkosh, WI 54902 |
Second Address | Oshkosh, WI 54902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 21/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T62720 | (02) | WI |