Healthcare Provider Details

I. General information

NPI: 1376646695
Provider Name (Legal Business Name): ROWENA C PUNZALAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 N 18TH ST
MILWAUKEE WI
53233-2121
US

IV. Provider business mailing address

8085 RIVERS AVE STE 100
NORTH CHARLESTON SC
29406-9239
US

V. Phone/Fax

Practice location:
  • Phone: 414-937-6573
  • Fax:
Mailing address:
  • Phone: 843-569-8495
  • Fax: 770-237-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number36081020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number36081
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: