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NPI Code Detail

MEDICARE: MR. DAVID F DEVRIES PA-C

MEDICARE: MR. DAVID F DEVRIES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant515-023WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831204080
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID F DEVRIES PA-C
Provider Business Mailing Address
First Line : 3301 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2843
Country : US
Telephone Number : 414-647-6326
Fax Number : 414-671-8860
Provider Business Practice Location Address
First Line : 2483 CORPORATE CIR
Second Line :
City : EAST TROY
State : WI
Zip : 53120-2575
Country : US
Telephone Number : 262-642-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 03/07/2023

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