Healthcare Provider Details

I. General information

NPI: 1558567735
Provider Name (Legal Business Name): PREETHA Y KURUDIYARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 MILLER PARK WAY
WEST MILWAUKEE WI
53214-3604
US

IV. Provider business mailing address

17820 HICKORY CT
BROOKFIELD WI
53045-5010
US

V. Phone/Fax

Practice location:
  • Phone: 414-306-7120
  • Fax: 414-672-6026
Mailing address:
  • Phone: 414-559-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number49289
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49289
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number49289
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: