Basic Information
| Provider Information | |||||||||
| NPI: | 1215542683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLANDERS | ||||||||
| FirstName: | CARY | ||||||||
| MiddleName: | WILKINS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6250 W COLLEGE AVE | ||||||||
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| City: | GREENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531292801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163076407 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2350 N LAKE DR | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532114528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142987280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2020 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 09/13/2020 | ||||||||
| NPIReactivationDate: | 11/18/2021 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5602-23 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.