# PISANG LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316302797
- **Authorized official:** BENNY KUSUMA M.D. (SOLE OWNER)
- **Authorized official phone:** (316) 209-1424

## Contact information

- **Practice address:** 37868 US HIGHWAY 18, PRAIRIE DU CHIEN, WI 53821-8416
- **Practice address phone:** (702) 453-3799
- **Practice address fax:** (702) 453-5741
- **Mailing address:** PO BOX 3602, LA CROSSE, WI 54602-3602
- **Mailing address phone:** (702) 453-3799
- **Mailing address fax:** (702) 453-5741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 52325-20 | WI | Yes |
| 207R00000X | Internal Medicine Physician | 54950 | MN | — |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |

## Other

- **Enumeration date:** 12/29/2015
- **Last updated:** 12/29/2015