Provider Demographics
NPI:1851816862
Name:CUBIC LIFE INTEGRATIVE CARE S.C.
Entity Type:Organization
Organization Name:CUBIC LIFE INTEGRATIVE CARE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHNI
Authorized Official - Middle Name:LATA
Authorized Official - Last Name:RAMNANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-215-9955
Mailing Address - Street 1:325 FOREST GROVE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 FOREST GROVE DR STE 200
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3894
Practice Address - Country:US
Practice Address - Phone:414-375-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54487-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty