Healthcare Provider Details

I. General information

NPI: 1013811223
Provider Name (Legal Business Name): PRIMEMED TRADERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 N MILWAUKEE ST STE 300
MILWAUKEE WI
53202-3712
US

IV. Provider business mailing address

790 N MILWAUKEE ST STE 300
MILWAUKEE WI
53202-3712
US

V. Phone/Fax

Practice location:
  • Phone: 217-685-1612
  • Fax:
Mailing address:
  • Phone: 217-685-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAHITH DEVATHI
Title or Position: MD
Credential:
Phone: 217-685-1612