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Individual
UWA KALU
Active
Individual
UWA KALU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125056343
IL
207Q00000X
Family Medicine Physician
57764-20
WI
208M00000X
Hospitalist Physician
Primary
036128826
IL
208M00000X
Hospitalist Physician
57764-20
WI
Other
Enumeration date
06/17/2009
Last updated
07/05/2023
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