Provider Demographics
NPI:1811448723
Name:STAR MEDICAL ASSOCIATES OF MILWAUKEE, CO
Entity type:Organization
Organization Name:STAR MEDICAL ASSOCIATES OF MILWAUKEE, CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-427-7820
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-0935
Mailing Address - Country:US
Mailing Address - Phone:414-427-7820
Mailing Address - Fax:414-427-7824
Practice Address - Street 1:1038 W GLEN CROSSING DR
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-7467
Practice Address - Country:US
Practice Address - Phone:414-379-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty