Healthcare Provider Details

I. General information

NPI: 1497862643
Provider Name (Legal Business Name): K. PAUL KATAYAMA, MD SC DBA ADVANCED INSTITUTE OF FERTILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KINNICKINNIC RIVER PKWY SUITE 535
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY SUITE 535
MILWAUKEE WI
53215-3669
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-5437
  • Fax: 414-645-5401
Mailing address:
  • Phone: 414-645-5437
  • Fax: 414-645-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number19346
License Number StateWI

VIII. Authorized Official

Name: DR. K. PAUL KATAYAMA
Title or Position: PRESIDENT
Credential: M.D., PH.D.
Phone: 414-645-5437