Provider Demographics
NPI:1922082312
Name:PUREWAL, NAVTEJ S (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVTEJ
Middle Name:S
Last Name:PUREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:225 S EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4257
Mailing Address - Country:US
Mailing Address - Phone:262-787-6700
Mailing Address - Fax:262-439-7677
Practice Address - Street 1:3305 S 20TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4940
Practice Address - Country:US
Practice Address - Phone:262-767-6700
Practice Address - Fax:262-439-7677
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI34868-020207L00000X
WI34868208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF00356Medicare UPIN