Healthcare Provider Details

I. General information

NPI: 1184811440
Provider Name (Legal Business Name): BARRY K GIMBEL MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 N PORT WASH SU249
MILWAUKEE WI
53217-5474
US

IV. Provider business mailing address

5150 N PORT WASH SU249
MILWAUKEE WI
53217-5474
US

V. Phone/Fax

Practice location:
  • Phone: 414-964-0000
  • Fax: 414-964-2556
Mailing address:
  • Phone: 414-964-0000
  • Fax: 414-964-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA M ROLLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 414-964-0000