Provider Demographics
NPI:1407923790
Name:WADHWA, AJAY R (DR)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:R
Last Name:WADHWA
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4230
Mailing Address - Country:US
Mailing Address - Phone:414-224-3737
Mailing Address - Fax:
Practice Address - Street 1:229 E WISCONSIN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4230
Practice Address - Country:US
Practice Address - Phone:414-224-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2851-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43705900Medicaid