Healthcare Provider Details

I. General information

NPI: 1962791632
Provider Name (Legal Business Name): DR. RISHI SUBBARAYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E MILESTONE DR
APPLETON WI
54913-6701
US

IV. Provider business mailing address

2000 E MILESTONE DR
APPLETON WI
54913-6701
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-8131
  • Fax: 920-832-0444
Mailing address:
  • Phone: 920-731-8131
  • Fax: 920-832-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD174080
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number60926-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: