Goncharova, Irina

Goncharova, Irina is an individual health care provider with primary practice located at 2801 W Kinnickinnic River Pkwy Suite 485, Milwaukee WI 53215-3669. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Vascular Surgery is her primary health care specialty. Goncharova, Irina can be contacted via phone (414) 646-8900.

Contact Information

Primary practice address
2801 W Kinnickinnic River Pkwy Suite 485 Milwaukee WI 53215-3669
Phone: (414) 646-8900
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 03611663 Illinois
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 49279 Wisconsin

Profile Details

NPI number 1104857465
LBN Legal business name Goncharova, Irina
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Dec 27th, 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 1104857465 NPPES
Wisconsin MEDICAID 34885400

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