Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 18369020 | WI |
NPI | 1194715995 |
---|---|
Provider Name | Patrick W Cummings |
First Address | Brookfield, WI 53045-4199 |
Second Address | West Allis, WI 53227-2455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30132900 | (05) | WI |
B52257 | (02) | WI |