Healthcare Provider Details

I. General information

NPI: 1760369318
Provider Name (Legal Business Name): ARMEN BAGDASAROV MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

212 S BARCLAY ST APT 309
MILWAUKEE WI
53204-1468
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-6600
  • Fax:
Mailing address:
  • Phone: 267-414-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: