=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447293931
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM J PAO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 09/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 PORT WASHINGTON RD
-----------------------------------------------------
City | GRAFTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53024-9201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-329-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11516 N PORT WASHINGTON RD STE 107
-----------------------------------------------------
City | MEQUON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53092-3478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-241-5040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 30607-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------