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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 3 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 1194712455 NPPES
Wisconsin MEDICAID 31539700

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