Healthcare Provider Details

I. General information

NPI: 1992181408
Provider Name (Legal Business Name): JAMES WILLIAM GELDER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E GENEVA SQ
LAKE GENEVA WI
53147-9694
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-249-5000
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3636-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: