Healthcare Provider Details

I. General information

NPI: 1255367454
Provider Name (Legal Business Name): PRACTICE MANAGEMENT GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DELAFIELD STREET STE 218
WAUKESHA WI
53188-3403
US

IV. Provider business mailing address

1111 DELAFIELD STREET SUITE 218
WAUKESHA WI
53188-3403
US

V. Phone/Fax

Practice location:
  • Phone: 262-574-9093
  • Fax: 262-542-2803
Mailing address:
  • Phone: 262-574-9093
  • Fax: 262-542-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HARINDER S GILL
Title or Position: PARTNER
Credential: M.D.
Phone: 262-542-0074