Individual provider · NPI-1

Timothy Michael Gordon, EMT- Paramedic

Emergency Medical Technician, Paramedic · Milwaukee, WI

NPI number1972275055
StatusActive
Last updated in NPPESSep 28, 2021

Details

NPI
1972275055
Entity type
Individual (NPI-1)
Name
Timothy Michael Gordon
Credential
EMT- Paramedic
Sex
Male
Sole proprietor
No
Enumeration date
Sep 28, 2021
Certification date
Sep 28, 2021
Last updated
Sep 28, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
146L00000X Emergency Medical Technician, Paramedic41348WIYes

Practice location

10233 W Greenfield Ave
Milwaukee, WI 53214-3911

Phone 414-727-5750

Mailing address

1497 Rivers Edge Pkwy
Oconomowoc, WI 53066-6908

Phone 262-490-4854

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