MEDICARE: DR. PREETHA Y KURUDIYARA 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	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	49289	WI
2	208000000X	Pediatrics Physician	49289	WI
3	2080A0000X	Pediatric Adolescent Medicine Physician	49289	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	:	1558567735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PREETHA Y KURUDIYARA MD

Provider Business Mailing Address
First Line	:	17820 HICKORY CT
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-5010
Country	:	US
Telephone Number	:	414-559-6924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 MILLER PARK WAY
Second Line	:
City	:	WEST MILWAUKEE
State	:	WI
Zip	:	53214-3604
Country	:	US
Telephone Number	:	414-306-7120
Fax Number	:	414-672-6026

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	09/11/2025

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