Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 17508 | WI |
NPI | 1063461556 |
---|---|
Provider Name | Mr. Roger D. Cohen |
First Address | Milwaukee, WI 53226-4837 |
Second Address | Milwaukee, WI 53226-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30965200 | (05) | WI |
B84777 | (02) |