Provider Demographics
NPI:1669569828
Name:S. PAUL KUWAYAMA, MD, SC
Entity type:Organization
Organization Name:S. PAUL KUWAYAMA, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KUWAYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-641-6893
Mailing Address - Street 1:11035 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2541
Mailing Address - Country:US
Mailing Address - Phone:262-641-6893
Mailing Address - Fax:
Practice Address - Street 1:11035 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2541
Practice Address - Country:US
Practice Address - Phone:262-641-6893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31223000Medicaid
WIB54392Medicare UPIN