DR. IRINA GONCHAROVA (NPI# 1104857465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104857465 |
| Entity Type | Individual |
| Full Name | DR. IRINA GONCHAROVA |
| Credential | MD |
| Practice Address |
2801 W Kinnickinnic River Pkwy Suite 485 Milwaukee WI 53215-3669 |
| Practice Telephone | 4146468900 |
| Mailing Telephone | 4146468900 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2014-09-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 03611663 | IL | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
49279 | WI | Allopathic & Osteopathic Physicians |
| Street Address |
2801 W KINNICKINNIC RIVER PKWY SUITE 485 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53215-3669 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215930391 | Anthony C Defranco | Internal Medicine | 2801 W Kinnickinnic River Pkwy, Suite 840, Milwaukee, WI 53215-3669 | 2005-05-23 |
| 1114530987 | Michelle A Krueger | Nurse Practitioner | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2020-08-31 |
| 1538772397 | Nicholas J Kajdan | Registered Nurse | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2020-08-31 |
| 1376184549 | Alix Mertens | Physician Assistant | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215 | 2019-09-30 |
| 1235789363 | Andrea S Ganzke | Nurse Practitioner | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2019-09-20 |
| 1003461336 | Vanja Z Rissky | Nurse Practitioner | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2019-08-05 |
| 1881246346 | Kevin Nehil | Physician Assistant | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2019-07-15 |
| 1295387975 | Ann M Mayer | Nurse Practitioner | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2019-07-12 |
| 1265994727 | Rachel Krueger | Occupational Therapist | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2019-04-03 |
| 1518446707 | Cailin K Loose | Nurse Practitioner | 2801 W Kinnickinnic River Pkwy, Milwaukee, WI 53215-3669 | 2018-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841829918 | Joshua Michael Brooks | Student in an Organized Health Care Education/Training Program | Aurora St. Lukes Medical Center 2901 W Oklahoma Ave, Milwaukee, WI 53215 | 2020-04-02 |
| 1053967091 | Kristina Strupp | Clinical Nurse Specialist | 2900 W. Oaklahoma Avenue, Milwaukee, WI 53215 | 2019-08-15 |
| 1427510296 | Madelyn Pickle | Student in an Organized Health Care Education/Training Program | 2801 W. Kinnickinnic Rd Ste 250, Milwaukee, WI 53215 | 2019-04-02 |
| 1932601838 | Elizabeth D Morawski | Nurse Practitioner | 2801 Kinnickinnic Parkway, Suite 630, Milwaukee, WI 53215 | 2018-03-06 |
| 1457872673 | Canzata Kimberly Dent | Counselor | 2727 W. Cleveland Suite 204, Milwaukee, WI 53215 | 2017-06-28 |
| 1538689955 | Christian Pena | Durable Medical Equipment & Medical Supplies | 2800 W Forest Home Ave, Suite 100, Milwaukee, WI 53215 | 2017-06-27 |
| 1386178804 | Dane A Olsen | Family Medicine | 801 W Kinnickinnic River Pkwy., Suite 250, Milwaukee, WI 53215 | 2017-04-12 |
| 1811443492 | Thomas Diamond | Physical Therapist | 2901 Kinnickinnic Parkway, Milwaukee, WI 53215 | 2016-09-01 |
| 1487055133 | Sam Khalili | Otolaryngology | 2801 W Kinnickinnic River Pkwy # 680, Milwaukee, WI 53215 | 2014-09-12 |
| 1992105621 | Nicole R Hall | Nurse Practitioner | 2901 S Kinnickinnic Ave, Milwaukee, WI 53215 | 2014-08-29 |
| Find all providers in zip 53215 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932308186 | Great Lakes Medical & Surgical Center | Surgery | 6000 South 27th Street, Milwaukee, WI 53221 | 2007-07-17 |
| 1821352683 | Neel Anand Mansukhani | Surgery | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2012-06-26 |
| 1770731077 | Rajeev Gupta | Surgery | 2801 W Kinnickinnic River Pkwy Ste 330, Milwaukee, WI 53215-3678 | 2008-08-29 |
| 1639353204 | Anilkumar Singh Md Sc | Surgery | 2745 W Layton Ave, Suite 202, Milwaukee, WI 53221-2651 | 2007-12-19 |
| 1912045097 | Patricia E Burrows | Surgery | 9000 W Wisconsin Ave, Ms 721, Milwaukee, WI 53226-4874 | 2007-02-02 |
| 1285727453 | John Wilson Bowman | Surgery | 11414 W Park Pl, Ste 300, Milwaukee, WI 53224-3500 | 2006-10-02 |
| 1629006887 | Joseph Patrick Hart | Surgery | 9200 W Wisconsin Ave, Milwaukee, WI 53226-3522 | 2006-06-28 |
| 1154375400 | Kellie R Brown | Surgery | 9200 W Wisconsin Ave, Division of Vascular Surgery, Milwaukee, WI 53226-3522 | 2006-05-20 |
| 1205888948 | Brian D Lewis | Surgery | 9200 W Wisconsin Ave, Vascular Surgery, Milwaukee, WI 53226-3522 | 2006-05-17 |
| 1407809148 | Gary Seabrook | Surgery | 9200 W Wisconsin Ave, Vascular Surgery, Milwaukee, WI 53226-3522 | 2006-05-17 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.