Provider Demographics
NPI:1255423026
Name:PARENT, GERARD THOMAS (MD)
Entity type:Individual
Prefix:
First Name:GERARD
Middle Name:THOMAS
Last Name:PARENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:2901 WEST KINNICKINNIC RIVER PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-649-3790
Practice Address - Fax:414-649-5648
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30153200Medicaid
WIP00707810OtherRR MEDICARE
WI46236-4635Medicare PIN
WIP00707810OtherRR MEDICARE
WI30153200Medicaid