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1134314362 NPI number — WILSON H LUY TAN, MD LTD

NPI Number: 1134314362
Health Care Provider/Practitioner: WILSON H LUY TAN, MD LTD

Information about “1134314362” NPI (WILSON H LUY TAN, MD LTD) exists in 1134314362 in HTML format HTML  |  1134314362 in plain Text format TXT  |  1134314362 in PDF (Portable Document Format) PDF  |  1134314362 in an XML format XML  formats.

NPI Number : 1134314362 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1134314362",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WILSON H LUY TAN, MD LTD",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "705 S UNIVERSITY AVE",
    "SecondLineMailingAddress": "SUITE 380",
    "MailingAddressCityName": "BEAVER DAM",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53916-3053",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-887-3460",
    "MailingAddressFaxNumber": "920-887-3491",
    "FirstLinePracticeLocationAddress": "705 S UNIVERSITY AVE",
    "SecondLinePracticeLocationAddress": "SUITE 380",
    "PracticeLocationAddressCityName": "BEAVER DAM",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53916-3053",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-887-3460",
    "PracticeLocationAddressFaxNumber": "920-887-3491",
    "EnumerationDate": "09/11/2007",
    "LastUpdateDate": "09/11/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "LUY TAN",
    "AuthorizedOfficialFirstName": "WILSON",
    "AuthorizedOfficialMiddleName": "H",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "920-887-3460",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084N0400X",
        "TaxonomyName": "Neurology Physician",
        "LicenseNumber": "28716-020",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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