Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 23928 | WI |
NPI | 1003843772 |
---|---|
Provider Name | Steven Bondow |
First Address | Milwaukee, WI 53226-3462 |
Second Address | Milwaukee, WI 53226-3462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 31/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30529900 | (05) | WI |
B51649 | (02) |