Healthcare Provider Details

I. General information

NPI: 1790521938
Provider Name (Legal Business Name): LUCKSHI RAJENDRAN MD, FRCSC, FACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. LUCKSHIKA RAJENDRAN

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date: 04/03/2025
Reactivation Date: 10/17/2025

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6400
  • Fax: 414-955-0213
Mailing address:
  • Phone: 414-805-6400
  • Fax: 414-955-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number87812-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: