Healthcare Provider Details

I. General information

NPI: 1780926188
Provider Name (Legal Business Name): BRINTHA F VASAGAR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3522 W LISBON AVE
MILWAUKEE WI
53208-1953
US

IV. Provider business mailing address

3522 W LISBON AVE
MILWAUKEE WI
53208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 414-935-8000
  • Fax: 414-344-3350
Mailing address:
  • Phone: 414-935-8000
  • Fax: 414-344-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0013090
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: