1164611497 NPI number — JOAN T. HARNEY GNADT, MD, SC

Table of content: (NPI 1164611497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164611497 NPI number — JOAN T. HARNEY GNADT, MD, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOAN T. HARNEY GNADT, MD, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164611497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13133 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
MEQUON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-243-6000
Provider Business Mailing Address Fax Number:
262-243-6007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13133 N PORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-243-6000
Provider Business Practice Location Address Fax Number:
262-243-6007
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GNADT
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-243-6000

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  28835 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28835 . This is a "WI LICENCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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