Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4001893015 | WI |
NPI | 1053537373 |
---|---|
Provider Name | Mr. Robert Albert Kay |
First Address | Marshfield, WI 54449 |
Second Address | Marshfield, WI 54449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33652000 | (05) | WI |