IndividualActive
Charlie Gordon
NPI 1457561045 · Driver · Milwaukee, WI
Provider details
- NPI number
- 1457561045
- Entity type
- Individual
- Primary specialty
- DriverOther Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- G635-1107-1325-04 (WI)
Practice location
1000 N 92nd St
Milwaukee, WI 53226-3533
Phone: (414) 479-9400
Fax: (414) 259-1663
Mailing address
3730 W Capitol Dr
Milwaukee, WI 53216-2539
Registry dates
- Enumerated
- 2007-05-23
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.