Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207L00000X | Anesthesiology | | 01066745A | INDIANA | No |
| 2 | 207L00000X | Anesthesiology | | 10904 | NORTH DAKOTA | No |
| 3 | 207L00000X | Anesthesiology | | 58255-20 | WISCONSIN | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 11014110 | MEDICAID | WISCONSIN | |
| 2 | 249110T | MEDICARE PIN | INDIANA | |
| 3 | 144MR | OTHER | NORTH CAROLINA | BCBS PROVIDER NUMBER |
| 4 | 52Z310 | MEDICARE OSCAR/CERTIFICATION | WISCONSIN | |
| 5 | 1871958 | OTHER | NORTH CAROLINA | UHC PROVIDER NUMBER |
| 6 | 2062419 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDICARE PROVIDER NUMBER |
| 7 | 000000613636 | OTHER | INDIANA | ANTHEM-INDIANA |
| 8 | 16186 | OTHER | NORTH CAROLINA | PARTNERS PROVIDER NUMBER |
| 9 | 1326349135 | OTHER | WISCONSIN | CMH SB NPI |
| 10 | P00732890 | OTHER | INDIANA | RR MEDICARE |
| 11 | 00439 | MEDICARE PIN | WISCONSIN | |
| 12 | 200944960 | MEDICAID | INDIANA | |
| 13 | 521310 | MEDICARE OSCAR/CERTIFICATION | WISCONSIN | |
| 14 | 1851477913 | OTHER | WISCONSIN | CMH NPI |
| 15 | I46389 | MEDICARE UPIN | NORTH CAROLINA | |
