Healthcare Provider Details

I. General information

NPI: 1619154952
Provider Name (Legal Business Name): PRITIKA BHATIA, M.D., LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST STE 150
MILWAUKEE WI
53215-4940
US

IV. Provider business mailing address

225 S EXECUTIVE DR
BROOKFIELD WI
53005-4257
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-3725
  • Fax:
Mailing address:
  • Phone: 262-787-4026
  • Fax: 262-782-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number46103
License Number StateWI

VIII. Authorized Official

Name: DR. PRITIKA BHATIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-787-4026