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General NPI Number Information
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NPI Number | 1063754125
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Entity Type | Individual
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Provider Name | PRERNA RAJ PANDYA M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVENUE UROGYNECOLOGY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-3666
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Fax | 414-805-6622
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Provider Business Mailing Address
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Address Line | 9200 W WISCONSIN AVENUE UROGYNECOLOGY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-3666
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Fax | 414-805-6622
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 72958
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License Number State | WI
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