Healthcare Provider Details

I. General information

NPI: 1366126468
Provider Name (Legal Business Name): SILVIA FANNY LARA-MOSES MD, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

IV. Provider business mailing address

925 N 87TH ST
MILWAUKEE WI
53226-4812
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-2020
  • Fax: 414-955-6300
Mailing address:
  • Phone: 414-955-2020
  • Fax: 414-955-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number85462-875
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001620-P.A.
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number3279381
License Number StateZZ
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001620-P.A.
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001620-P.A.
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: