Healthcare Provider Details

I. General information

NPI: 1396375069
Provider Name (Legal Business Name): HAKSHA HEALTHCARE S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4931 S 27TH ST STE 300
GREENFIELD WI
53221-2653
US

IV. Provider business mailing address

4931 S 27TH ST STE 300
GREENFIELD WI
53221-2653
US

V. Phone/Fax

Practice location:
  • Phone: 855-942-5742
  • Fax: 877-942-5742
Mailing address:
  • Phone: 855-942-5742
  • Fax: 414-810-4148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KSHAMA KESHAVA BHAT
Title or Position: PRESIDENT
Credential: MD
Phone: 855-942-5742