Individual
DR. TRACY A PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4111 W MITCHELL ST, STE 300, MILWAUKEE, WI 53215-1748
(414) 385-8800
Mailing address
4111 W MITCHELL ST, STE 300, MILWAUKEE, WI 53215-1748
(414) 385-8800
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
30606
WI
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
30606-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31539700
—
WI
Enumeration date
10/03/2005
Last updated
01/26/2023
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