1811448723 NPI number — STAR MEDICAL ASSOCIATES OF MILWAUKEE, CO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811448723 NPI number — STAR MEDICAL ASSOCIATES OF MILWAUKEE, CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAR MEDICAL ASSOCIATES OF MILWAUKEE, CO
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:
1811448723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 935
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALES CORNERS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53130-0935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-427-7820
Provider Business Mailing Address Fax Number:
414-427-7824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1038 W GLEN CROSSING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK CREEK
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53154-7467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-379-7501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HIRPARA
Authorized Official First Name:
JAYANT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-427-7820

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  51823 , 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)





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