1235194499 NPI number — PATRICIA MARY BARWIG MD

Table of content: PATRICIA MARY BARWIG MD (NPI 1235194499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235194499 NPI number — PATRICIA MARY BARWIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARWIG
Provider First Name:
PATRICIA
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARWIG
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
ANDRES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235194499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19475 W NORTH AVE
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53045-4199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-780-4000
Provider Business Mailing Address Fax Number:
262-780-4090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19475 W NORTH AVE
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53045-4199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-780-4000
Provider Business Practice Location Address Fax Number:
262-780-4090
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  24458 , 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: 30647100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32813500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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