Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 51897-020 | WI |
N | 111NI0900X | Internist | 51897-020 | WI |
Y | 207RR0500X | Rheumatology | 51897-020 | WI |
NPI | 1073692901 |
---|---|
Provider Name | Dr. Jonathan Kushi |
First Address | Glendale, WI 53217-3879 |
Second Address | Glendale, WI 53217-3879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 10/09/2012 |