Provider Demographics
NPI:1609886324
Name:IYER, PALLAVI (MD)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2860
Mailing Address - Fax:414-266-6749
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2860
Practice Address - Fax:414-266-6749
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225532080P0205X
ALMD.355162080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1609886324Medicaid
FL28638OtherBLUE CROSS BLUE SHIELD
FL28638OtherBLUE CROSS BLUE SHIELD
FL273291200Medicaid