Basic Information
| Provider Information | |||||||||
| NPI: | 1700086410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'SOUZA | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | DIVISION OF NEOPLASTIC DISEASES | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148054600 | ||||||||
| FaxNumber: | 4148056815 | ||||||||
| Practice Location | |||||||||
| Address1: | 9200 W WISCONSIN AVE | ||||||||
| Address2: | DIVISION OF NEOPLASTIC DISEASES | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148054600 | ||||||||
| FaxNumber: | 4148056815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 53303 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 61263 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | 4301090585 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | 104962 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0000X | 53303 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | P00898125 | 01 | RAIL ROAD - MEDICARE | OTHER | ENROLLED | 05 | IA | MEDICAID | 1700086410 | 05 | WI | MEDICAID | ENROLLED | 05 | MN | MEDICAID |