Healthcare Provider Details

I. General information

NPI: 1417566084
Provider Name (Legal Business Name): AVANI SUSHILKUMAR MOHTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

775 GATE HOUSE LN UNIT 2
BROOKFIELD WI
53005-5780
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-0437
  • Fax: 414-955-0093
Mailing address:
  • Phone: 510-335-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number82287-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.077206
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number82287-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: