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General NPI Number Information
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NPI Number | 1952569816
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Entity Type | Organization
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Legal Business Name | GREATER MILWAUKEE CRITICAL CARE AND PULMONARY ASSOCIATES SC
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 3201 S 16TH ST 2015
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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 | 414-840-0198
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 070520
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City | MILWAUKEE
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State | WI
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Zip | 53207-0520
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Country | US
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Telephone | 414-840-0198
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DR. RAKESH WAGHRAY
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Credential | MD
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Telephone | 414-840-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 39828
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 45393
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License Number State | WI
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