Provider Demographics
NPI:1073857876
Name:AJIT B DIVGI M.D.,L.L.C.
Entity type:Organization
Organization Name:AJIT B DIVGI M.D.,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIVGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-781-6521
Mailing Address - Street 1:18980 DANBURY CT
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-8163
Mailing Address - Country:US
Mailing Address - Phone:262-781-6521
Mailing Address - Fax:262-781-6563
Practice Address - Street 1:3267 S 16TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4500
Practice Address - Country:US
Practice Address - Phone:262-781-6521
Practice Address - Fax:262-781-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21657207RH0003X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568453223OtherNPI NUMBER -1-INDIVIDUAL