Healthcare Provider Details

I. General information

NPI: 1376717736
Provider Name (Legal Business Name): CMAP, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 75TH ST STE 103
KENOSHA WI
53142-8200
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 262-697-4304
  • Fax: 262-925-8409
Mailing address:
  • Phone: 800-883-7243
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number43667
License Number StateWI

VIII. Authorized Official

Name: DR. REEMA SANGHVI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 800-883-7243