Healthcare Provider Details

I. General information

NPI: 1083195010
Provider Name (Legal Business Name): GADEER AYESH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 S 27TH ST
GREENFIELD WI
53221-3764
US

IV. Provider business mailing address

5233 S 27TH ST
GREENFIELD WI
53221-3764
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-5850
  • Fax:
Mailing address:
  • Phone: 414-727-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4498
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: