Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | 1337 | WI |
Y | 225100000X | Physical Therapist | 1902 | WI |
NPI | 1154650034 |
---|---|
Provider Name | Mr. Kenneth James Uebele |
First Address | Green Bay, WI 54301-3921 |
Second Address | Green Bay, WI 54301-3921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2009 |
Last Update Date | 23/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41783500 | (05) | WI |