Gavin, Andrea Maria

Gavin, Andrea Maria is an individual health care provider with primary practice located at 2600 Kiley Way , Plymouth WI 53073-5020. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Gavin, Andrea Maria can be contacted via phone (920) 449-7000.

Contact Information

Primary practice address
2600 Kiley Way Plymouth WI 53073-5020
Phone: (920) 449-7000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 30392 Wisconsin

Profile Details

NPI number 1669587655
LBN Legal business name Gavin, Andrea Maria
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2006
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669587655 NPPES
Wisconsin MEDICAID 31632400

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