Provider Demographics
NPI:1134348733
Name:PEREZ, JOSEPH A (PA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W KILBOURN AVE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1330
Mailing Address - Country:US
Mailing Address - Phone:414-219-5080
Mailing Address - Fax:
Practice Address - Street 1:1218 W KILBOURN AVE
Practice Address - Street 2:SUITE 511
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1330
Practice Address - Country:US
Practice Address - Phone:414-219-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42906000Medicaid
WI42906000Medicaid
WI001902615Medicare ID - Type Unspecified