Provider Demographics
NPI:1740489202
Name:KAUSHIK, MANU (MBBS, MD)
Entity type:Individual
Prefix:DR
First Name:MANU
Middle Name:
Last Name:KAUSHIK
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:CARDIOVASCULAR MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-6777
Mailing Address - Fax:
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:CARDIOVASCULAR MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39157207RC0000X, 207RI0011X
WI65987207RC0000X, 207RI0011X, 207RC0000X, 207RI0011X
NE26211207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1740489202Medicaid