Provider Demographics
NPI:1831260405
Name:CJ HUSSUSSIAN MD SC
Entity type:Organization
Organization Name:CJ HUSSUSSIAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUSSUSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-970-5600
Mailing Address - Street 1:N4W22370 BLUEMOUND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1683
Mailing Address - Country:US
Mailing Address - Phone:262-970-5600
Mailing Address - Fax:262-970-5950
Practice Address - Street 1:N4W22370 BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1683
Practice Address - Country:US
Practice Address - Phone:262-970-5600
Practice Address - Fax:262-970-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46664-020208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34515700Medicaid
WI000169000Medicare ID - Type Unspecified
WI34515700Medicaid