Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 49399 | WI |
NPI | 1013932615 |
---|---|
Provider Name | Thomas B Huizenga |
First Address | Milwaukee, WI 53211-2265 |
Second Address | Glendale, WI 53212-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 23/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34874500 | (05) | WI |
I59887 | (02) | WI |