Provider Demographics
NPI:1003919697
Name:BABUSUKUMAR, PUSHPARANEE (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHPARANEE
Middle Name:
Last Name:BABUSUKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 30TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1632
Mailing Address - Country:US
Mailing Address - Phone:262-652-7813
Mailing Address - Fax:262-652-4450
Practice Address - Street 1:3535 30TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1632
Practice Address - Country:US
Practice Address - Phone:262-652-7813
Practice Address - Fax:262-652-4450
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI339300202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31964500Medicaid
G01618Medicare UPIN
WI46197Medicare ID - Type Unspecified