Active NPI
Elena V Roukhadze, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Milwaukee, WI
National Provider Identifier
1003078494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 51124-020
- Practice address
- 5000 W National Ave
Milwaukee, WI 53295-0001 - Phone
- (414) 384-2000
- Fax
- (414) 389-4187
- NPI assigned
- Jun 27, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 51124-020 | WI | Primary |
Addresses
Primary practice location
5000 W National Ave
Milwaukee, WI 53295-0001
Mailing address
5000 W National Ave
Milwaukee, WI 53295-0001
Phone (414) 384-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 51124-020 | WI | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214524800000",
"number": "1003078494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 W NATIONAL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532950001",
"telephone_number": "414-384-2000",
"fax_number": "414-389-4187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 W NATIONAL AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532950001",
"telephone_number": "414-384-2000",
"fax_number": "414-389-4187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROUKHADZE",
"first_name": "ELENA",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-27",
"last_updated": "2008-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "WI",
"license": "51124-020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.