Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 41656 | WI |
NPI | 1003883976 |
---|---|
Provider Name | Paul C. Mariskanish |
First Address | Prairie Du Chien, WI 53821-8416 |
Second Address | Prairie Du Chien, WI 53821-8416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H02935 | (02) | WI |