Healthcare Provider Details

I. General information

NPI: 1639580574
Provider Name (Legal Business Name): JOSEPH ABRAHAM PARKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 WESTHILL DR STE 102
WAUSAU WI
54401-4706
US

IV. Provider business mailing address

825 N 90TH ST
OMAHA NE
68114-2702
US

V. Phone/Fax

Practice location:
  • Phone: 715-847-2019
  • Fax: 715-847-2668
Mailing address:
  • Phone: 402-391-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number1396
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number77066-21
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number77066-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: