Individual
DR. IRINA GONCHAROVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, SUITE 485, MILWAUKEE, WI 53215-3669
(414) 646-8900
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
03611663
IL
2086S0129X
Vascular Surgery Physician
Primary
49279
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34885400
—
WI
Enumeration date
07/05/2006
Last updated
12/27/2023
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