Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 40020 | WI |
Y | 207RA0201X | Internist - Allergy & Immunology | 40020 | WI |
NPI | 1568542140 |
---|---|
Provider Name | Reena A George |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Oak Creek, WI 53154-4563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 19/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55940 | (02) | WI |