Provider Demographics
NPI:1174822993
Name:KOLIMAS, NANDINI RISHI (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:NANDINI
Middle Name:RISHI
Last Name:KOLIMAS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC NEUROSURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6435
Mailing Address - Fax:414-955-0131
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC NEUROSURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6435
Practice Address - Fax:414-955-0131
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2654-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174822993Medicaid
WI68086 0842Medicare PIN
WI73601 2090Medicare PIN