Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 25992 | WI |
Y | 207RH0003X | Hematology & Oncology | 25992 | WI |
NPI | 1326039074 |
---|---|
Provider Name | William G Matthaeus |
First Address | Milwaukee, WI 53209-2042 |
Second Address | Milwaukee, WI 53226-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30850600 | (05) | WI |
B54882 | (02) | |
P00823727 | RR MEDICARE (01) | WI |