=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225293137
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH H. YUSKA, MD, SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2008
-----------------------------------------------------
Last Update Date | 07/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4726 EAST TOWNE BLVD. 110
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-663-4550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4726 EAST TOWNE BLVD. 110
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-663-4550
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. KENNETH H YUSKA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 608-663-4550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 21898
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------