Park, Tracy A
Park, Tracy A is an individual health care provider with primary practice located at 4111 W Mitchell St Ste 300, Milwaukee WI 53215-1748. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Neuromuscular Medicine. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Park, Tracy A can be contacted via phone (414) 385-8800.Contact Information
Primary practice address
4111 W Mitchell St Ste 300
Milwaukee WI 53215-1748
Phone: (414) 385-8800
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | 30606 | Wisconsin |
| Allopathic & Osteopathic Physicians / Neuromuscular Medicine | 2081N0008X | 30606-020 | Wisconsin |
Profile Details
| NPI number | 1194712455 |
|---|---|
| LBN Legal business name | Park, Tracy A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 3rd, 2005 |
| Last updated | Jan 26th, 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 | 1194712455 | NPPES |
| Wisconsin | MEDICAID | 31539700 |
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