Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 48042 | WI |
NPI | 1598711665 |
---|---|
Provider Name | Ms. Monica Vasudev |
First Address | Sheboygan, WI 53081-3129 |
Second Address | Sheboygan, WI 53081-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1598711665 | (05) | WI |
34836900 | (05) | WI |
I53765 | (02) | WI |