Basic Information
Provider Information | |||||||||
NPI: | 1760491336 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHELIMSKY | ||||||||
FirstName: | GISELA | ||||||||
MiddleName: | G | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9000 W WISCONSIN AVE | ||||||||
Address2: | PEDIATRIC GASTROENTEROLOGY | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532264874 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4142663690 | ||||||||
FaxNumber: | 4142663676 | ||||||||
Practice Location | |||||||||
Address1: | 9000 W WISCONSIN AVE | ||||||||
Address2: | PEDIATRIC GASTROENTEROLOGY | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532264874 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4142663690 | ||||||||
FaxNumber: | 4142663676 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2006 | ||||||||
LastUpdateDate: | 08/29/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | 35-062443 | OH | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 2080P0206X | 56475 | WI | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 000000182741 | 01 | OH | ANTHEM | OTHER | 000000525886 | 01 | OH | ANTHEM | OTHER | 10025555600 | 01 | NE | NE MEDICAID | OTHER | 1760491336 | 05 | WI |   | MEDICAID | 2102969 | 01 | OH | AETNA | OTHER | 739162 | 01 | OH | BUCKEYE | OTHER | 000000221377 | 01 | OH | UNISON | OTHER | 0018470140001 | 01 | PA | PA MEDICAID | OTHER | 0315797 | 01 | OH | BCMH | OTHER | 0315797 | 05 | OH |   | MEDICAID | 363415 | 01 | OH | WELLCARE | OTHER |