Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | WI | |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 21353020 | WI |
NPI | 1790960433 |
---|---|
Provider Name | Mr. Bruce R Krygowski |
First Address | Plover, WI 54677-2832 |
Second Address | Plover, WI 54677-2832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2007 |
Last Update Date | 31/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B54354 | (02) |