Healthcare Provider Details

I. General information

NPI: 1760433510
Provider Name (Legal Business Name): WILLIAM GREAVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 N BAYSIDE DR
MILWAUKEE WI
53217-1910
US

IV. Provider business mailing address

8851 N BAYSIDE DR
MILWAUKEE WI
53217-1910
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-2762
  • Fax: 414-352-1345
Mailing address:
  • Phone: 414-352-2762
  • Fax: 414-352-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number24314
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: