Healthcare Provider Details

I. General information

NPI: 1063489615
Provider Name (Legal Business Name): RAMAGOPAL J TUMULURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18200 W CAPITOL DR STE 200
BROOKFIELD WI
53045-1446
US

IV. Provider business mailing address

PO BOX 2040
MILWAUKEE WI
53201-2040
US

V. Phone/Fax

Practice location:
  • Phone: 262-444-5148
  • Fax: 262-444-5457
Mailing address:
  • Phone: 262-444-5148
  • Fax: 262-444-5457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number39301020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number39301
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: