Individual
TIMOTHY RAYMOND GENGEMBRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1650 PILGRIM PKWY, ELM GROVE, WI 53122-1531
(262) 366-8985
Mailing address
1650 PILGRIM PKWY, ELM GROVE, WI 53122-1531
(262) 366-8985
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
245-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42908600
—
WI
Enumeration date
07/28/2008
Last updated
08/20/2025
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