Healthcare Provider Details

I. General information

NPI: 1801683438
Provider Name (Legal Business Name): EGWE ELVIS AKEME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S MORELAND BLVD
WAUKESHA WI
53188-4909
US

IV. Provider business mailing address

215 S MORELAND BLVD
WAUKESHA WI
53188-4909
US

V. Phone/Fax

Practice location:
  • Phone: 408-661-3993
  • Fax:
Mailing address:
  • Phone: 408-661-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number0019817
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number0019817
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: