Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 73196-20 | WI |
NPI | 1053708511 |
---|---|
Provider Name | Dr. Rishi Kora |
First Address | Glendale, WI 53209-4446 |
Second Address | Glendale, WI 53209-4447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100099499 | (05) | WI |