Healthcare Provider Details

I. General information

NPI: 1447333232
Provider Name (Legal Business Name): SONIA BOPARAI GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DEPARTMENT OF RADIOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DEPARTMENT OF RADIOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3122
  • Fax: 414-805-3777
Mailing address:
  • Phone: 414-805-3122
  • Fax: 414-805-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number47769-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number47769
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: