Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 16517 | WI |
NPI | 1710904792 |
---|---|
Provider Name | S. Paul Kuwayama |
First Address | Hales Corners, WI 53130-2541 |
Second Address | Hales Corners, WI 53130-2541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31223000 | (05) | WI |
B54392 | (02) |