Basic Information
Provider Information
NPI: 1780679795
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GARVEY
FirstName: CHRISTOPHER
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3003 W GOOD HOPE RD
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532092042
CountryCode: US
TelephoneNumber: 4143523100
FaxNumber:  
Practice Location
Address1: 1640 E SUMNER ST
Address2:  
City: HARTFORD
State: WI
PostalCode: 530272684
CountryCode: US
TelephoneNumber: 2626704000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2005
LastUpdateDate: 11/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XME94047FLN Other Service ProvidersSpecialist 
207Y00000X42750WIY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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