Healthcare Provider Details

I. General information

NPI: 1922013655
Provider Name (Legal Business Name): KRISHNA S. NENI, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3267 S 16TH ST #103
MILWAUKEE WI
53215-4500
US

IV. Provider business mailing address

3267 S 16TH ST #103
MILWAUKEE WI
53215-4500
US

V. Phone/Fax

Practice location:
  • Phone: 414-671-1449
  • Fax:
Mailing address:
  • Phone: 414-671-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28948
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number28326
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number45393
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number39828
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1915023
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1176023
License Number StateWI

VIII. Authorized Official

Name: BRIDGET KIRKISH
Title or Position: OFFICE MANAGER
Credential:
Phone: 414-671-1449