Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 34682 | WI |
NPI | 1235106089 |
---|---|
Provider Name | Vicken R Vorperian |
First Address | Waukesha, WI 53188-5071 |
Second Address | Waukesha, WI 53188-5071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 15/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31942600 | (05) | WI |
F61063 | (02) | WI |