Individual
TAI H KWON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-2300
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
24197
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30416400
—
WI
01
—
P00064340
RAILROAD MEDICARE
WI
Enumeration date
12/15/2005
Last updated
05/12/2008
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