Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 34221 | WI |
NPI | 1184653362 |
---|---|
Provider Name | Tobias Enright |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Menomonee Falls, WI 53051-2810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30359800 | (05) | WI |
E24645 | (02) | WI |
P00452786 | RR MEDICARE (01) | WI |