Provider Demographics
NPI:1255949079
Name:SAGUD, MILKA (NP)
Entity type:Individual
Prefix:
First Name:MILKA
Middle Name:
Last Name:SAGUD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-773-4312
Mailing Address - Fax:414-422-2188
Practice Address - Street 1:S74W16775 JANESVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-7742
Practice Address - Country:US
Practice Address - Phone:414-422-2430
Practice Address - Fax:414-422-2188
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10192363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100102517Medicaid
WI100102549Medicaid