Healthcare Provider Details

I. General information

NPI: 1982817771
Provider Name (Legal Business Name): PRIYA ASIJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 W CAPITOL DR STE 200
BROOKFIELD WI
53045-1446
US

IV. Provider business mailing address

18200 W CAPITOL DR STE 200
BROOKFIELD WI
53045-1446
US

V. Phone/Fax

Practice location:
  • Phone: 262-444-2158
  • Fax:
Mailing address:
  • Phone: 262-444-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49188
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: