Gray, Theresa

Gray, Theresa is an individual health care provider with primary practice located at 3522 W Lisbon Ave , Milwaukee WI 53208-1953. She recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is her primary health care specialty. Gray, Theresa can be contacted via phone (414) 935-8000.

Contact Information

Primary practice address
3522 W Lisbon Ave Milwaukee WI 53208-1953
Phone: (414) 935-8000
Fax: (414) 344-3350
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 1111-25 Wisconsin
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 1111-25 Wisconsin

Profile Details

NPI number 1386025377
LBN Legal business name Gray, Theresa
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2015
Last updated Jun 22nd, 2020 - about 6 years ago

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 1386025377 NPPES
Wisconsin MEDICAID 100076793

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