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General NPI Number Information
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NPI Number | 1417029620
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Entity Type | Organization
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Legal Business Name | PHYSIATRISTS ASSOCIATES, LTD
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3201 S 16TH ST 800
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City | MILWAUKEE
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State | WI
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Zip | 53215-4537
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Country | US
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Telephone | 414-647-9985
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1790
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City | BROOKFIELD
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State | WI
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Zip | 53008-1790
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENDAVAR M GOPAL
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Credential | M.D.
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Telephone | 414-647-9985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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