Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 14237020 | WI |
NPI | 1003075573 |
---|---|
Provider Name | Prof. Marvin Lyle Birnbaum |
First Address | Madison, WI 53705-2167 |
Second Address | Madison, WI 53705-2167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |