Healthcare Provider Details

I. General information

NPI: 1003940966
Provider Name (Legal Business Name): JESSICA MARIE GHAFERI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARIE FLYNN

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5320
  • Fax: 414-805-5320
Mailing address:
  • Phone: 414-805-5320
  • Fax: 414-805-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD174001
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number84970
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number4301087739
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301087739
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number4301087739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: