Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 67615 | WI |
NPI | 1033538590 |
---|---|
Provider Name | Pankaj Jain |
First Address | Appleton, WI 54915-1305 |
Second Address | Appleton, WI 54915-1305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033538590 | (05) | WI |