Individual
POBTSUAS THOJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4330 NAKOOSA TRL APT 2, MADISON, WI 53714-1354
(608) 572-2516
Mailing address
4330 NAKOOSA TRL APT 2, MADISON, WI 53714-1354
(608) 572-2516
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
WI
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
555-555-55551
NONE
WI
01
—
NONE
NONE
WI
Enumeration date
10/11/2021
Last updated
10/11/2021
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