Individual
MARIA A PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
9200 W WISCONSIN AVENUE, COLORECTAL SURGERY, MILWAUKEE, WI 53226-3522
(414) 955-5783
(414) 955-0087
Mailing address
9200 W WISCONSIN AVENUE, COLORECTAL SURGERY, MILWAUKEE, WI 53226-3522
(414) 955-5783
(414) 955-0087
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
3119-23
WI
363AM0700X
Medical Physician Assistant
Primary
3119-23
WI
363AS0400X
Surgical Physician Assistant
3119-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104263979
—
WI
Enumeration date
06/03/2013
Last updated
01/08/2024
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