DR. IRINA GONCHAROVA MD NPI 1104857465

NPI Information

NPI: 1104857465
Provider Name: DR. IRINA GONCHAROVA, MD
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

PECOS Registration: Yes

Address:
2801 W KINNICKINNIC RIVER PKWY
SUITE 485
MILWAUKEE, WI
ZIP 53215
Phone: (414) 646-8900
Get Directions

DR. Irina Goncharova, MD is a vascular surgery surgery in Milwaukee, WI with 25 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. DR. Irina Goncharova, MD NPI is 1104857465. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF CHICAGO, PRITZKER SCHOOL OF MEDICINE
Graduation Year:1999

The provider's business location address is:

2801 W KINNICKINNIC RIVER PKWY
SUITE 485
MILWAUKEE, WI
ZIP 53215-669
Phone: (414) 646-8900

The NPI 1104857465 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/5/2006 and was last updated on 12/27/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208600000X	Surgery		03611663	ILLINOIS	No
2	2086S0129X	Surgery	Vascular Surgery	49279	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	34885400	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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