Individual
DR. MARK PUSHKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1545 S LAYTON BLVD, SUITE 307, MILWAUKEE, WI 53215-1924
(414) 217-2858
Mailing address
4440 N MARYLAND AVE, SHOREWOOD, WI 53211-1651
(414) 217-2858
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
908
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39038000
—
WI
Enumeration date
05/23/2006
Last updated
07/08/2007
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