MEDICARE: JAYANT KHITHA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	49012020	WI
2	207RI0011X	Interventional Cardiology Physician	49012020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184829475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYANT KHITHA MD

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	800-326-2250
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 W KINNICKINNIC RIVER PKWY STE 840
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3678
Country	:	US
Telephone Number	:	414-649-3530
Fax Number	:	414-649-3551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/14/2025

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Directions to “ JAYANT KHITHA MD” Practice Location

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