Individual
ILVA E VAN VALKENBURGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
305 W SILVER SPRING DR, GLENDALE, WI 53217
(414) 885-0080
(414) 885-0081
Mailing address
305 W SILVER SPRING DR, GLENDALE, WI 53217
(414) 885-0080
(414) 885-0081
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
38221020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32302400
—
WI
01
—
K400278502
MEDICARE PTAN
WI
Enumeration date
10/20/2006
Last updated
12/07/2022
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