Passow, Tara
Passow, Tara is an individual health care provider with primary practice located at 700 Hillcrest Ct , Beaver Dam WI 53916-2418. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as her primary health care specialty. Passow, Tara can be contacted via phone (920) 885-2622.Contact Information
Primary practice address
700 Hillcrest Ct
Beaver Dam WI 53916-2418
Phone: (920) 885-2622
Fax: (920) 885-4419
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 24736 | Wisconsin |
Profile Details
| NPI number | 1780619163 |
|---|---|
| LBN Legal business name | Passow, Tara |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2006 |
| Last updated | Mar 20th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780619163 | NPPES |
| Wisconsin | MEDICAID | 30631900 |
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