Provider Demographics
NPI:1902067564
Name:KUSBA, JILL (DVM)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:KUSBA
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14350 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2317
Mailing Address - Country:US
Mailing Address - Phone:262-781-5993
Mailing Address - Fax:262-781-3262
Practice Address - Street 1:14350 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2317
Practice Address - Country:US
Practice Address - Phone:262-781-5993
Practice Address - Fax:262-781-3262
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1958174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian