Provider Demographics
NPI:1710193891
Name:MONRAD, PRIYA ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:ALEXANDRA
Last Name:MONRAD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC NEUROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3464
Mailing Address - Fax:414-266-3466
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC NEUROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3464
Practice Address - Fax:414-266-3466
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN512072084N0400X
MI4301088438208000000X
MN1037252084N0400X
WI558992084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN130001373Medicare PIN