Individual
GWENN K. PAVLOVITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
975 PORT WASHINGTON ROAD, SUITE 320, GRAFTON, WI 53024-9201
(262) 387-8100
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
27056
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30668300
—
WI
01
—
P00914018
RR MEDICARE
WI
Enumeration date
07/01/2006
Last updated
05/24/2011
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