Healthcare Provider Details

I. General information

NPI: 1609812544
Provider Name (Legal Business Name): RHEUMATIC DISEASE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N PORT WASHINGTON RD
GLENDALE WI
53217-3879
US

IV. Provider business mailing address

7080 N PORT WASHINGTON RD
GLENDALE WI
53217-3879
US

V. Phone/Fax

Practice location:
  • Phone: 414-351-4009
  • Fax: 414-351-7060
Mailing address:
  • Phone: 414-351-4009
  • Fax: 414-351-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN KUSHI
Title or Position: PHYSICIAN
Credential: MD
Phone: 414-351-4009