Basic Information
| Provider Information | |||||||||
| NPI: | 1194792895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRUESSING | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3033 S 27TH ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149086601 | ||||||||
| FaxNumber: | 4143852980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 W KK RIVER PKWY | ||||||||
| Address2: | SUITE 1030 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149086500 | ||||||||
| FaxNumber: | 4143852980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 357-023 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.