Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 38666 | WI |
NPI | 1063408573 |
---|---|
Provider Name | Peggy Tong |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Milwaukee, WI 53209-2042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32332500 | (05) | WI |
G29235 | (02) | |
P00602507 | RR MEDICARE (01) | WI |