Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 8225-851 | WI |
NPI | 1003379488 |
---|---|
Provider Name | Traci Deanna Pawlitschek |
First Address | Madison, WI 53726-3941 |
Second Address | Madison, WI 53792-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2019 |
Last Update Date | 18/06/2020 |