Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 51576 | WI |
NPI | 1376738336 |
---|---|
Provider Name | Mrs. Oscar C Wille |
First Address | Glendale, WI 53212-1082 |
Second Address | Milwaukee, WI 53211-4508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 12/06/2012 |