Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 56179-20 | WI |
NPI | 1003043381 |
---|---|
Provider Name | Rita Sabeti |
First Address | Elm Grove, WI 53122-2605 |
Second Address | Elm Grove, WI 53122-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2009 |
Last Update Date | 29/03/2021 |