Healthcare Provider Details

I. General information

NPI: 1275036089
Provider Name (Legal Business Name): ALLISON KAZUMI IKEDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

IV. Provider business mailing address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

V. Phone/Fax

Practice location:
  • Phone: 262-253-5400
  • Fax: 262-253-3399
Mailing address:
  • Phone: 262-253-5400
  • Fax: 262-253-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number88036-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberML60858116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: