PREVAIL PSYCHIATRY LLC (NPI# 1417322868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417322868 |
| Entity Type | Organization |
| Organization Name | PREVAIL PSYCHIATRY LLC |
| Practice Address |
2222 N Mayfair Rd Wauwatosa WI 53226-2208 |
| Practice Telephone | 2627167580 |
| Mailing Telephone | 2627167580 |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |
| Authorized Official Name | JUSTIN HANSON (OWNER) |
| Authorized Official Telephone | 2627167580 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
2222 N MAYFAIR RD |
| City | WAUWATOSA |
| State | WI |
| Zip Code | 53226-2208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235578709 | Aasiyah Clark | Counselor | 2222 N Mayfair Rd, Wauwatosa, WI 53226-2262 | 2013-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912511155 | Alexander Harlan | Pharmacist | 900 N 92nd St, Milwaukee, WI 53226 | 2020-09-04 |
| 1558985762 | Armghan Haider Ans | Student in an Organized Health Care Education/Training Program | 9200 W. Wisconsin Ave. Froedtert Hospital & Medical Col, Milwaukee, WI 53226 | 2020-06-03 |
| 1669001103 | Kimberly Tyler | Student in an Organized Health Care Education/Training Program | 8701 W Watertown Plank Road, Medical College of Wisconsin Dept of Internal Medicine, Wauwatosa, WI 53226 | 2020-04-06 |
| 1972131993 | Francesca Meloy Devine | Student in an Organized Health Care Education/Training Program | Medical Education Office: Children's Corporate Center, 999 N. 92nd St., Suite 730, Milwaukee, WI 53226 | 2020-03-27 |
| 1285275248 | Sharitta Alford | Technician | 12250 West North Avenue, Apartment 142b, Wauwatosa, WI 53226 | 2019-10-01 |
| 1619528023 | Linda Marie Sabatinelli | Technician | 12107 W. Woodland Ave, Wauwatosa, WI 53226 | 2019-09-26 |
| 1598310195 | Matthew Laviolette | Surgery | Medical College of Wisconsin, 8701 Watertown Plank Rd., Surgical Oncology, Milwaukee, WI 53226 | 2019-08-09 |
| 1962056432 | Lyndsey Marie Bratberg | Physician Assistant | F&mcw Clinical Cancer Center 9200 W. Wisconsin Ave., Milwaukee, WI 53226 | 2019-08-01 |
| 1659832855 | Benjamin David Seadler | Surgery | Mcw, Department of Surgery, 8701 Watertown Plank Road, Milwaukee, WI 53226 | 2019-03-29 |
| 1861953267 | Michael Dryden | Student in an Organized Health Care Education/Training Program | 8701 Watertown Plank Rd., Milwaukee, WI 53226 | 2019-03-27 |
| Find all providers in zip 53226 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780730515 | Sheila W. Sorkin, M.d. LLC | Psychiatry & Neurology | 11430 W Bluemound Rd, Suite 109, Wauwatosa, WI 53226-4050 | 2007-01-26 |
| 1568577534 | Sheila W Sorkin | Psychiatry & Neurology | 11430 W. Bluemound Road Suite 109, Wauwatosa, WI 53226 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538352323 | Stephen B Hull | Psychiatry & Neurology | 8315 Steeple Hill Dr, Larsen, WI 54947-9538 | 2007-08-24 |
| 1124148747 | Ivars Gailans | Psychiatry & Neurology | 180 N Milwaukee St, Milwaukee, WI 53202-6013 | 2007-03-29 |
| 1548206360 | William Carlin Bucknam | Psychiatry & Neurology | 1018 Gammon Ln, Madison, WI 53719-2256 | 2006-06-21 |
| 1205873882 | Paul W Harris | Psychiatry & Neurology | 3267 S 16tj Street, Room 200, Milwaukee, WI 53215-4500 | 2006-06-01 |
| 1417461401 | Jennifer Lynn Brubaker | Psychiatry & Neurology | 2842 S Business Dr, Sheboygan, WI 53081-6518 | 2017-11-29 |
| 1184868598 | Richard K Wagner | Psychiatry & Neurology | 903 Mineral Point Ave, Janesville, WI 53548-2970 | 2009-04-29 |
| 1740469873 | Raymond W. Moy Md Sc | Psychiatry & Neurology | 6917 W Oklahoma Ave, Milwaukee, WI 53219-2973 | 2007-10-25 |
| 1487709200 | Matthew A Felgus | Psychiatry & Neurology | 6333 Odana Rd, Suite 3, Madison, WI 53719-1170 | 2007-01-24 |
| 1811055940 | Frederic B Will | Psychiatry & Neurology | 4810 Northwestern Ave, Racine, WI 53406-1504 | 2006-12-04 |
| 1598833410 | Edgar Basil Jackson | Psychiatry & Neurology | 1225 W Mitchell St, 223, Milwaukee, WI 53204-3383 | 2006-11-30 |
| Find all providers with the same taxonomy | ||||
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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.