Individual
TARA PASSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
700 HILLCREST CT, BEAVER DAM, WI 53916-2418
(920) 885-2622
(920) 885-4419
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 683-5278
(920) 663-9009
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
24736
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30631900
—
WI
Enumeration date
07/12/2006
Last updated
03/20/2012
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