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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104857465 | NPPES |
| Wisconsin | MEDICAID | 34885400 |
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