Provider Demographics
NPI:1194792895
Name:PRUESSING, PAUL (PA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:PRUESSING
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3033 S 27TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3600
Mailing Address - Country:US
Mailing Address - Phone:414-908-6601
Mailing Address - Fax:414-385-2980
Practice Address - Street 1:2801 W KK RIVER PKWY
Practice Address - Street 2:SUITE 1030
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-908-6500
Practice Address - Fax:414-385-2980
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI357-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIR97764Medicare UPIN