Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 1002245 | WI |
NPI | 1073930459 |
---|---|
Provider Name | Paul Pamula |
First Address | Chicago, IL 60631-2261 |
Second Address | Mount Pleasant, WI 53406-4654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 23/06/2020 |