Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 18494 | WI |
NPI | 1730251331 |
---|---|
Provider Name | Mr. Terrence J Wilkins |
First Address | Glendale, WI 53212-1082 |
Second Address | Milwaukee, WI 53211-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 12/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30261200 | (05) | WI |
B57618 | (02) |