| NPI | 1427005107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES R HERON Authorized Official 920-498-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2020-08-22 |