MEDICARE: DR. PROMISE DZAKPASU M.D.

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
1	208000000X	Pediatrics Physician	36766	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1881691418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PROMISE DZAKPASU M.D.

Provider Business Mailing Address
First Line	:	9000 W WISCONSIN AVE # MS 958
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-4874
Country	:	US
Telephone Number	:	414-266-7615
Fax Number	:	414-266-6238

Provider Business Practice Location Address
First Line	:	4655 N PORT WASHINGTON RD STE 200
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53212-1076
Country	:	US
Telephone Number	:	414-247-9530
Fax Number	:	414-247-1875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/21/2022

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Directions to “ DR. PROMISE DZAKPASU M.D.” Practice Location

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