Provider Demographics
NPI:1225293137
Name:KENNETH H. YUSKA, MD, SC
Entity Type:Organization
Organization Name:KENNETH H. YUSKA, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:YUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-663-4550
Mailing Address - Street 1:4726 EAST TOWNE BLVD.
Mailing Address - Street 2:110
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715
Mailing Address - Country:US
Mailing Address - Phone:608-663-4550
Mailing Address - Fax:
Practice Address - Street 1:4726 EAST TOWNE BLVD.
Practice Address - Street 2:110
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715
Practice Address - Country:US
Practice Address - Phone:608-663-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21898207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30219900Medicaid
WI21898OtherWISCONSIN LICENSE
WI30219900Medicaid