Provider Demographics
NPI:1255526190
Name:KESHAVA BHAT, KSHAMA (MD)
Entity type:Individual
Prefix:
First Name:KSHAMA
Middle Name:
Last Name:KESHAVA BHAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KSHAMA
Other - Middle Name:
Other - Last Name:KARODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19385 ASHBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3835
Mailing Address - Country:US
Mailing Address - Phone:414-369-9649
Mailing Address - Fax:877-942-5742
Practice Address - Street 1:2500 W LAYTON AVE STE 10
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5400
Practice Address - Country:US
Practice Address - Phone:414-281-9665
Practice Address - Fax:833-391-2172
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53449-20207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255526190Medicaid