Healthcare Provider Details

I. General information

NPI: 1477747954
Provider Name (Legal Business Name): HIMANSHU AGRAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 ELM GROVE RD STE 110
ELM GROVE WI
53122-2528
US

IV. Provider business mailing address

1155 N MAYFAIR RD FL 3
MILWAUKEE WI
53226-3464
US

V. Phone/Fax

Practice location:
  • Phone: 262-393-3320
  • Fax: 262-404-8961
Mailing address:
  • Phone: 715-566-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number47305
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number50879
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number50879-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: