| NPI | 1568810364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN LIEBESKIND Owner 920-915-2584 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 44592) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 44592) |
| 2080B0002X Pediatrics Obesity Medicine (Licence: WI 44592) | |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2023-10-01 |