Basic Information
| Provider Information | |||||||||
| NPI: | 1891025722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESHMUKH | ||||||||
| FirstName: | TEJASWINI | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | PEDIATRIC RADIOLOGY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142661686 | ||||||||
| FaxNumber: | 4142661525 | ||||||||
| Practice Location | |||||||||
| Address1: | 9000 W WISCONSIN AVE | ||||||||
| Address2: | PEDIATRIC RADIOLOGY | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532264874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142661686 | ||||||||
| FaxNumber: | 4142661525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/25/2009 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 2011019862 | MO | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085P0229X | 2011019862 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | 2011019862 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | 2011019862 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085P0229X | 57383 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1891025722 | 05 | WI | MEDICAID |