Healthcare Provider Details

I. General information

NPI: 1457396970
Provider Name (Legal Business Name): PAUL S SANTARELLI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W RAWSON AVE #200
FRANKLIN WI
53132-9417
US

IV. Provider business mailing address

3077 N MAYFAIR RD STE 305
WAUWATOSA WI
53222-4305
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-4320
  • Fax: 414-761-1921
Mailing address:
  • Phone: 414-384-6700
  • Fax: 414-727-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1980
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: