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 | 207RC0001X | Internal Medicine | Clinical Cardiac Electrophysiology | 036-105281 | ILLINOIS | No |
| 2 | 207RC0001X | Internal Medicine | Clinical Cardiac Electrophysiology | 34483-020 | 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 | 000060295-0003 | MEDICARE ID-TYPE UNSPECIFIED | | SHEBOY & OSHKOSH COUNTIES |
| 2 | 32637500 | OTHER | WISCONSIN | NETWORK HEALTH T19 |
| 3 | 32637500 | OTHER | | AMERICHOICE T19 |
| 4 | 7782095 | OTHER | | AETNA |
| 5 | 32637500 | OTHER | | MANAGED HEALTH SERVICES |
| 6 | P00258579 | MEDICARE ID-TYPE UNSPECIFIED | | RAILROAD MEDICARE |
| 7 | 1135 73-601 | MEDICAID | WISCONSIN | |
| 8 | 000052075-0003 | MEDICARE ID-TYPE UNSPECIFIED | | RACINE COUNTY |
| 9 | 1473529 | OTHER | | CIGNA |
| 10 | 32637500 | OTHER | | ABRI HEALTHCARE T19 |
| 11 | 0362 68-086 | MEDICARE PIN | WISCONSIN | |
| 12 | 32637500 | OTHER | WISCONSIN | INDEPENDENT CARE ICARE |
| 13 | H11682 | MEDICARE UPIN | | |
| 14 | 000002535-0003 | MEDICARE ID-TYPE UNSPECIFIED | | MILWAUKEE COUNTY |
| 15 | 1952403818 | MEDICAID | WISCONSIN | |