Healthcare Provider Details

I. General information

NPI: 1609811421
Provider Name (Legal Business Name): NUNZIO A. GAGLIANELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DIVISION OF CARDIOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DIVISION OF CARDIOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6633
  • Fax: 414-805-6280
Mailing address:
  • Phone: 414-805-6633
  • Fax: 414-805-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number51293
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number51293
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: