Organization
CUBIC LIFE INTEGRATIVE CARE S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KESHNI LATA RAMNANAN MD (OWNER)
(414) 215-9955
Entity
Organization
Contact information
Practice address
325 FOREST GROVE DR STE 200, PEWAUKEE, WI 53072-3894
(414) 375-2800
Mailing address
325 FOREST GROVE DR STE 200, PEWAUKEE, WI 53072-3894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
54487-20
WI
Other
Enumeration date
08/10/2017
Last updated
08/10/2017
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