Basic Information
Provider Information
NPI: 1033558143
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUMBHAR
FirstName: SACHIN
MiddleName: SHIVAJI
NamePrefix: MR.
NameSuffix:  
Credential: MBBS, MD.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9000 W WISCONSIN AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532264874
CountryCode: US
TelephoneNumber: (414) 607-5280
FaxNumber: 4142661525
Practice Location
Address1: 9000 W WISCONSIN AVE
Address2:  
City: MILWAUKEE
State: WI
PostalCode: 532264874
CountryCode: US
TelephoneNumber: (414) 607-5280
FaxNumber: 4142661525
Other Information
ProviderEnumerationDate: 06/21/2013
LastUpdateDate: 09/07/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085B0100X67503WIY Allopathic & Osteopathic PhysiciansRadiologyBody Imaging
2085B0100XML60387848WAN Allopathic & Osteopathic PhysiciansRadiologyBody Imaging
2085R0202XML60387848WAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X67503WIN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
103355814305WI MEDICAID


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