Provider Demographics
NPI:1235229568
Name:GAVINSKI, MARY PARISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PARISH
Last Name:GAVINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY ALICE
Other - Middle Name:PARISH
Other - Last Name:GAVINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 BISHOPS WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6247
Mailing Address - Country:US
Mailing Address - Phone:262-207-9318
Mailing Address - Fax:414-672-3994
Practice Address - Street 1:205 BISHOPS WAY
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6247
Practice Address - Country:US
Practice Address - Phone:262-207-9318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26129207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine