MEDICARE: JOSEPH W GRAVEL JR. MD

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	207Q00000X	Family Medicine Physician	72010-20	WI
2	207Q00000X	Family Medicine Physician	70283	MA

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	:	1205824786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH W GRAVEL JR. MD

Provider Business Mailing Address
First Line	:	8701 W WATERTOWN PLANK RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3548
Country	:	US
Telephone Number	:	414-955-8878
Fax Number	:	414-955-0064

Provider Business Practice Location Address
First Line	:	2400 W VILLARD AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-4901
Country	:	US
Telephone Number	:	414-527-8348
Fax Number	:	414-527-8046

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/03/2024

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