Provider Demographics
NPI:1447289566
Name:PAVLOVITZ, GWENN K (MD)
Entity type:Individual
Prefix:
First Name:GWENN
Middle Name:K
Last Name:PAVLOVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GWENN
Other - Middle Name:K
Other - Last Name:GRABOYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:975 PORT WASHINGTON ROAD
Practice Address - Street 2:SUITE 320
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9201
Practice Address - Country:US
Practice Address - Phone:262-387-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27056208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00914018OtherRR MEDICARE
WI30668300Medicaid
WIB55640Medicare UPIN
WI46236-0220Medicare PIN
WI01994-0220Medicare PIN