Provider Demographics
NPI:1922013655
Name:KRISHNA S. NENI, M.D., S.C.
Entity Type:Organization
Organization Name:KRISHNA S. NENI, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-671-1449
Mailing Address - Street 1:3267 S 16TH ST
Mailing Address - Street 2:#103
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4500
Mailing Address - Country:US
Mailing Address - Phone:414-671-1449
Mailing Address - Fax:
Practice Address - Street 1:3267 S 16TH ST
Practice Address - Street 2:#103
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4500
Practice Address - Country:US
Practice Address - Phone:414-671-1449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28948207R00000X
WI28326207RC0200X
WI45393207RC0200X
WI39828207RP1001X
WI1915023363AM0700X
WI1176023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32887800Medicaid
WICT0646OtherRAILROAD MEDICARE
WI32887800Medicaid