Provider Demographics
NPI:1255514212
Name:PAIS, PRIYA (MD)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:PAIS
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC NEPHROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-337-7140
Mailing Address - Fax:414-337-7145
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC NEPHROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-337-7140
Practice Address - Fax:414-337-7145
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2012-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1132572080P0210X
WI466432080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255514212Medicaid
WI35137400Medicaid
WI119373601Medicare PIN