Provider Demographics
NPI:1164601050
Name:KAUSKIK, RICHA (MD)
Entity Type:Individual
Prefix:
First Name:RICHA
Middle Name:
Last Name:KAUSKIK
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 1:515 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4491
Mailing Address - Country:US
Mailing Address - Phone:701-328-9956
Mailing Address - Fax:701-328-9957
Practice Address - Street 1:515 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4491
Practice Address - Country:US
Practice Address - Phone:701-328-9956
Practice Address - Fax:701-328-9957
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL10227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12083Medicaid
ND12083Medicaid