Healthcare Provider Details

I. General information

NPI: 1669569828
Provider Name (Legal Business Name): S. PAUL KUWAYAMA, MD, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11035 W FOREST HOME AVE
HALES CORNERS WI
53130-2541
US

IV. Provider business mailing address

11035 W FOREST HOME AVE
HALES CORNERS WI
53130-2541
US

V. Phone/Fax

Practice location:
  • Phone: 262-641-6893
  • Fax:
Mailing address:
  • Phone: 262-641-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: S. PAUL KUWAYAMA
Title or Position: OWNER
Credential: M.D.
Phone: 262-641-6893