Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 27062 | WI |
N | 2080P0201X | Pediatric Allergist | 27062 | WI |
NPI | 1134180045 |
---|---|
Provider Name | Thomas C Puchner JR. |
First Address | Fitchburg, WI 53711-5299 |
Second Address | Fitchburg, WI 53711-5299 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 05/08/2021 |