MEDICARE: RUPI PUREWAL OFFICE MANAGER

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1164939856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUPI PUREWAL OFFICE MANAGER

Provider Business Mailing Address
First Line	:	1035 FOXKIRK DR
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-3739
Country	:	US
Telephone Number	:	262-510-3874
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 S 20TH ST STE 160
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4941
Country	:	US
Telephone Number	:	414-509-8826
Fax Number	:	414-509-8827

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

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/04/2018

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