Healthcare Provider Details

I. General information

NPI: 1720251903
Provider Name (Legal Business Name): AJAY SEHGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. AJAY SEHGAL

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 W WATERTOWN PLANK RD PSYCHIATRY DEPARTMENT, TOSA CENTER
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

8701 W WATERTOWN PLANK RD PSYCHIATRY DEPARTMENT, TOSA CENTER
MILWAUKEE WI
53226-3548
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301099951
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number53553020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: