Provider Demographics
NPI:1053708511
Name:KORA, RISHI (MD)
Entity type:Individual
Prefix:DR
First Name:RISHI
Middle Name:
Last Name:KORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 N GREEN BAY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4446
Mailing Address - Country:US
Mailing Address - Phone:414-431-5971
Mailing Address - Fax:414-434-0354
Practice Address - Street 1:5650 N GREEN BAY AVE STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-4447
Practice Address - Country:US
Practice Address - Phone:414-431-5971
Practice Address - Fax:414-434-0354
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73196-20207RN0300X, 207RN0300X
IL036.145707208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100099499Medicaid