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Organization
PISANG LLC
Active
Organization
PISANG LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENNY KUSUMA M.D. (SOLE OWNER)
(316) 209-1424
Entity
Organization
Contact information
Practice address
37868 US HIGHWAY 18, PRAIRIE DU CHIEN, WI 53821-8416
(702) 453-3799
(702) 453-5741
Mailing address
PO BOX 3602, LA CROSSE, WI 54602-3602
(702) 453-3799
(702) 453-5741
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
52325-20
WI
207R00000X
Internal Medicine Physician
54950
MN
208M00000X
Hospitalist Physician
—
NULL
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
12/29/2015
Last updated
12/29/2015
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