Healthcare Provider Details

I. General information

NPI: 1043504772
Provider Name (Legal Business Name): KUN-TAI HSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2011
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 N MAYFAIR RD STE T2600
WAUWATOSA WI
53226-3464
US

IV. Provider business mailing address

1155 N MAYFAIR RD STE T2600
WAUWATOSA WI
53226-3464
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-4263
  • Fax: 414-955-6286
Mailing address:
  • Phone: 414-955-4263
  • Fax: 414-955-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number77790-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number77790-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: