Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 47220 | WI |
NPI | 1063463719 |
---|---|
Provider Name | Scott Alan Schlidt |
First Address | Milwaukee, WI 53211-4518 |
Second Address | Milwaukee, WI 53211-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34564800 | (05) | WI |
I17640 | (02) | WI |