Active NPI
Nicholas Larue
- Perfusionist
- Milwaukee, WI
National Provider Identifier
1730680596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Perfusionist
- Practice address
- 8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548 - Phone
- (414) 955-8296
- NPI assigned
- Feb 26, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Perfusionist | 242T00000X | Primary |
Addresses
Primary practice location
8701 W Watertown Plank Rd
Milwaukee, WI 53226-3548
Mailing address
4520 N Wilson Dr Apt 3
Shorewood, WI 53211-1343
Phone (608) 397-0258
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6452628968 | Medicaid | WI |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519603200000",
"number": "1730680596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4520 N WILSON DR APT 3",
"city": "SHOREWOOD",
"state": "WI",
"postal_code": "532111343",
"telephone_number": "608-397-0258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8701 W WATERTOWN PLANK RD",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532263548",
"telephone_number": "414-955-8296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARUE",
"first_name": "NICHOLAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-26",
"last_updated": "2018-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "242T00000X",
"taxonomy_group": "",
"desc": "Perfusionist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6452628968",
"state": "WI"
}
],
"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 Feb 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.