Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 18220 | WI |
NPI | 1043253974 |
---|---|
Provider Name | Rolando A Macasaet |
First Address | Viroqua, WI 54665 |
Second Address | Viroqua, WI 54665-2057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B54722 | (02) | WI |