Organization
KIDNEY CARE HOME SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GANESH N PULLA M.D. (OWNER/MEDICAL DIRECTOR)
(262) 564-8636
Entity
Organization
Contact information
Practice address
6125 GREEN BAY RD STE 200, KENOSHA, WI 53142-2945
(262) 564-8636
(262) 564-8637
Mailing address
6125 GREEN BAY RD STE 200, KENOSHA, WI 53142-2945
(262) 564-8636
(262) 564-8637
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32537500
—
WI
Enumeration date
07/06/2022
Last updated
07/06/2022
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