MEDICARE: DR. JESSICA MARIE GHAFERI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician	MD174001	OR
2	207ND0900X	Dermatopathology Physician	84970	WI
3	207ND0900X	Dermatopathology Physician	4301087739	MI
4	207N00000X	Dermatology Physician	4301087739	MI
5	207ZD0900X	Dermatopathology (Pathology) Physician	4301087739	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003940966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA MARIE GHAFERI M.D.

Provider Business Mailing Address
First Line	:	9200 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3522
Country	:	US
Telephone Number	:	414-805-5320
Fax Number	:	414-805-5320

Provider Business Practice Location Address
First Line	:	9200 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3522
Country	:	US
Telephone Number	:	414-805-5320
Fax Number	:	414-805-5320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/05/2026

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Directions to “ DR. JESSICA MARIE GHAFERI M.D.” Practice Location

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