Healthcare Provider Details

I. General information

NPI: 1275127524
Provider Name (Legal Business Name): MADHULATHA PANTRANGI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST DEPT OF
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

110 S SCHMIDT AVE
MARSHFIELD WI
54449-2508
US

V. Phone/Fax

Practice location:
  • Phone: 920-268-7098
  • Fax:
Mailing address:
  • Phone: 920-268-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: