Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 61264 | MN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 66058 | WI |
NPI | 1023307170 |
---|---|
Provider Name | Quintin Cappelle |
First Address | Eau Claire, WI 54702-1510 |
Second Address | Onalaska, WI 54650-8679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 15/09/2020 |