Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | 036-113257 | IL |
Y | 2080P0210X | Pediatric Nephrologist | 46643 | WI |
NPI | 1255514212 |
---|---|
Provider Name | Priya Pais |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 29/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255514212 | (05) | WI |
35137400 | (05) | WI |