Healthcare Provider Details

I. General information

NPI: 1457531345
Provider Name (Legal Business Name): MILWAUKEE INTERNAL MEDICINE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 W BURLEIGH ST
MILWAUKEE WI
53222-5003
US

IV. Provider business mailing address

PO BOX 806
GRAFTON WI
53024-0806
US

V. Phone/Fax

Practice location:
  • Phone: 414-837-6300
  • Fax: 414-763-3602
Mailing address:
  • Phone: 262-483-8162
  • Fax: 665-713-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number243073
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALOK GOYAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 414-837-6300