Provider Demographics
NPI:1255328142
Name:RAJURKAR, PIYUSH K (MD)
Entity type:Individual
Prefix:
First Name:PIYUSH
Middle Name:K
Last Name:RAJURKAR
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 1:6020 S PACKARD AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-3028
Mailing Address - Country:US
Mailing Address - Phone:414-294-4660
Mailing Address - Fax:414-294-4396
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-281-0963
Practice Address - Fax:414-294-4396
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44292-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0800323OtherPRIMECARE
WI34192700Medicaid
WI391484998011OtherBC/CCARE
WI391484998OtherTAX ID
WI180046200OtherRR MEDICARE
WI0800323OtherPRIMECARE
WI34192700Medicaid
0565030002Medicare NSC
WI391484998OtherTAX ID
WIH61652Medicare UPIN
WI000947365Medicare ID - Type Unspecified
000947370Medicare PIN