Healthcare Provider Details

I. General information

NPI: 1710904792
Provider Name (Legal Business Name): S. PAUL KUWAYAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
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: 262-641-6888
  • Fax: 262-641-6880
Mailing address:
  • Phone: 262-641-6888
  • Fax: 262-641-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number16517
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: