Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 54041-20 | WI |
N | 2080P0202X | Pediatric Cardiologist | 54041-20 | WI |
NPI | 1124229406 |
---|---|
Provider Name | Nicholas H. Vonbergen |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/12/2021 |