Provider Demographics
NPI:1437360310
Name:ZVARA, KIMBERLEY LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:LAURA
Last Name:ZVARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLEY
Other - Middle Name:LAURA
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC PHYSICAL MEDICINE AND REHABILITATION
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-607-5280
Mailing Address - Fax:414-266-3485
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-607-5280
Practice Address - Fax:414-266-3485
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53333-20208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1437360310Medicaid
WI1437360310Medicaid
WI736012168Medicare PIN