Healthcare Provider Details

I. General information

NPI: 1568413839
Provider Name (Legal Business Name): SUJANI KAKUMANU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF WISCONSIN HOSPITAL 600 HIGHLAND AVE H4/831-8320
MADISON WI
53792-0001
US

IV. Provider business mailing address

UNIVERSITY OF WISCONSIN HOSPITAL 600 HIGHLAND AVE H4/831-8320
MADISON WI
53792-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-0572
  • Fax: 608-263-9830
Mailing address:
  • Phone: 608-263-0572
  • Fax: 608-263-9830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number50618-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number1367
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: