Provider Demographics
NPI:1578532776
Name:TSUJI, MILES KEI (MD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:KEI
Last Name:TSUJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 W BONNIWELL RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1602
Mailing Address - Country:US
Mailing Address - Phone:262-243-5969
Mailing Address - Fax:262-243-5212
Practice Address - Street 1:3070 N 51ST ST
Practice Address - Street 2:SUITE P309
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1645
Practice Address - Country:US
Practice Address - Phone:414-447-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI367572080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32156600Medicaid
WI32156600Medicaid