Healthcare Provider Details

I. General information

NPI: 1053708511
Provider Name (Legal Business Name): RISHI KORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 N GREEN BAY AVE STE 210
GLENDALE WI
53209-4447
US

IV. Provider business mailing address

5650 N GREEN BAY AVE STE 201
GLENDALE WI
53209-4446
US

V. Phone/Fax

Practice location:
  • Phone: 414-431-5971
  • Fax: 414-434-0354
Mailing address:
  • Phone: 414-431-5971
  • Fax: 414-434-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number73196-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: