Healthcare Provider Details

I. General information

NPI: 1336124585
Provider Name (Legal Business Name): NIMISH BHUPENDRA VAKIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

36500 AURORA DR
SUMMIT WI
53066-4899
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-5000
  • Fax:
Mailing address:
  • Phone: 262-434-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number34096-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number34096
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: