Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 75570 | WI |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 75570 | WI |
NPI | 1053842492 |
---|---|
Provider Name | Thanmayi Kaza |
First Address | Appleton, WI 54915-1408 |
Second Address | Appleton, WI 54915-1408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2017 |
Last Update Date | 29/12/2021 |