Healthcare Provider Details

I. General information

NPI: 1073647863
Provider Name (Legal Business Name): PRACHI STRIKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. PRACHI AGARWALA

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 S 103RD ST STE 210
MILWAUKEE WI
53227-4161
US

IV. Provider business mailing address

3365 S 103RD ST STE 210
MILWAUKEE WI
53227-4161
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-4800
  • Fax: 262-432-9004
Mailing address:
  • Phone: 414-228-4800
  • Fax: 262-432-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number73967-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301088116
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73967-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number54329
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: