Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 49209-020 | WI |
NPI | 1053365494 |
---|---|
Provider Name | Petar G Igic |
First Address | Madison, WI 53715-1830 |
Second Address | Madison, WI 53715-1830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053365494 | (05) | WI |