Healthcare Provider Details

I. General information

NPI: 1508831637
Provider Name (Legal Business Name): VARUN K SAXENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

IV. Provider business mailing address

3237 S 16TH ST
MILWAUKEE WI
53215-4526
US

V. Phone/Fax

Practice location:
  • Phone: 414-769-4040
  • Fax: 414-769-4041
Mailing address:
  • Phone: 414-769-4040
  • Fax: 414-769-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number21074
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: