Provider Demographics
NPI:1114198660
Name:GINGRASS, RUEDI PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:RUEDI
Middle Name:PETER
Last Name:GINGRASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 WELLAUER DR
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3767
Mailing Address - Country:US
Mailing Address - Phone:414-258-5757
Mailing Address - Fax:
Practice Address - Street 1:7130 WELLAUER DR
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3767
Practice Address - Country:US
Practice Address - Phone:414-258-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13707208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery