Healthcare Provider Details

I. General information

NPI: 1831168848
Provider Name (Legal Business Name): RAMAKRISHNAN SANKARAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W LAKE ST
FRIENDSHIP WI
53934-9699
US

IV. Provider business mailing address

PO BOX 40
FRIENDSHIP WI
53934-0040
US

V. Phone/Fax

Practice location:
  • Phone: 608-339-3331
  • Fax: 608-339-6975
Mailing address:
  • Phone: 608-339-3331
  • Fax: 608-339-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21345
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: