Individual
BASIL U MADUKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213
(414) 454-6539
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6539
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5300-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5300
WI
Other
Enumeration date
08/21/2013
Last updated
11/24/2021
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