Basic Information
| Provider Information | |||||||||
| NPI: | 1497821268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAVTEJ S PUREWAL MDSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 S EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530054257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627874026 | ||||||||
| FaxNumber: | 2627826040 | ||||||||
| Practice Location | |||||||||
| Address1: | 3305 S 20TH ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532154940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143842100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2006 | ||||||||
| LastUpdateDate: | 04/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | PUREWAL | ||||||||
| AuthorizedOfficialFirstName: | NAVTEJ | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4142816980 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 31974300 | 05 | WI | MEDICAID |