Provider Demographics
NPI:1164939856
Name:PUREWAL, RUPI (OFFICE MANAGER)
Entity Type:Individual
Prefix:
First Name:RUPI
Middle Name:
Last Name:PUREWAL
Suffix:
Gender:F
Credentials:OFFICE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 FOXKIRK DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3739
Mailing Address - Country:US
Mailing Address - Phone:262-510-3874
Mailing Address - Fax:
Practice Address - Street 1:3305 S 20TH ST STE 160
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4941
Practice Address - Country:US
Practice Address - Phone:414-509-8826
Practice Address - Fax:414-509-8827
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator