=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609464049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE MEDICAL GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2020
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5434 W CAPITOL DR STE 1
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-215-3500
-----------------------------------------------------
Fax | 414-215-3504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | W217N5445 TAYLORS WOODS DR
-----------------------------------------------------
City | MENOMONEE FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53051-6263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-251-3500
-----------------------------------------------------
Fax | 414-251-3504
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JASVIR KAUR KAILEY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 414-251-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------