Individual
MELISSA GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9200 W WISCONSIN AVE, WAUWATOSA, WI 53226-3522
(414) 805-4600
(414) 805-2934
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-4600
(414) 805-2934
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5139
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770116220
—
WI
Enumeration date
02/12/2020
Last updated
03/26/2021
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