Healthcare Provider Details

I. General information

NPI: 1366805715
Provider Name (Legal Business Name): KASA BLAINE PUGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASA BLAINE COOPER MD

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

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: 414-805-7400
  • Fax: 414-805-7388
Mailing address:
  • Phone: 414-805-7400
  • Fax: 414-805-7388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberE-15247
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number56387
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number87454-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: