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General NPI Number Information
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NPI Number | 1710157078
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Entity Type | Individual
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Provider Name | ISAAC MELGUIZO-GAVILANES M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 2801 W KINNICKINNIC RIVER PKWY STE 925
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City | MILWAUKEE
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State | WI
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Zip | 53215-3689
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Country | US
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Telephone | 414-384-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 W KINNICKINNIC RIVER PKWY STE 925
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City | MILWAUKEE
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State | WI
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Zip | 53215-3689
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Country | US
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Telephone | 414-384-5111
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A102171
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | P0638
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 68347-20
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License Number State | WI
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