Healthcare Provider Details

I. General information

NPI: 1720241342
Provider Name (Legal Business Name): GAURAV NARULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax: 414-647-5940
Mailing address:
  • Phone: 414-649-6000
  • Fax: 414-647-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number85595-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number244731
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number67817
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number244731
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number67817
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: