Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 25432 | WI |
NPI | 1295706695 |
---|---|
Provider Name | Theresa Siegert |
First Address | Mequon, WI 53092-3339 |
Second Address | Mequon, WI 53092-3339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31544100 | (05) | WI |
E23868 | (02) | WI |