Provider Demographics
NPI:1609812544
Name:RHEUMATIC DISEASE CENTER
Entity Type:Organization
Organization Name:RHEUMATIC DISEASE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-351-4009
Mailing Address - Street 1:7080 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3879
Mailing Address - Country:US
Mailing Address - Phone:414-351-4009
Mailing Address - Fax:414-351-7060
Practice Address - Street 1:7080 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3879
Practice Address - Country:US
Practice Address - Phone:414-351-4009
Practice Address - Fax:414-351-7060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIDA0039OtherMEDICARE RAILROAD
137195900OtherDEPT OF LABOR-OWCP
WI=========011OtherANTHEM BLUE CROSS BLUE SH
0845760001Medicare NSC
WI=========011OtherANTHEM BLUE CROSS BLUE SH