Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 45313-020 | WI |
NPI | 1003865015 |
---|---|
Provider Name | Stephen H Vander Sluis |
First Address | Madison, WI 53715-1830 |
Second Address | Madison, WI 53715-1830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 15/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003865015 | (05) | WI |
F60370 | (02) |