Healthcare Provider Details

I. General information

NPI: 1376606491
Provider Name (Legal Business Name): PALLAVI P. PATWARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PALLAVI P PRASAD

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-4479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036107900
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number336.068870
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: