Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1442 | WI |
NPI | 1154839140 |
---|---|
Provider Name | Sandra Koester |
First Address | Wauwatosa, WI 53226-4312 |
Second Address | Waukesha, WI 53188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2018 |
Last Update Date | 12/01/2018 |