Healthcare Provider Details

I. General information

NPI: 1306191432
Provider Name (Legal Business Name): RISHI A RAMAKRISHNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

IV. Provider business mailing address

W180N8085 TOWN HALL RD
MENOMONEE FALLS WI
53051-3518
US

V. Phone/Fax

Practice location:
  • Phone: 262-257-3060
  • Fax: 262-518-5052
Mailing address:
  • Phone: 262-257-3060
  • Fax: 262-518-5052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036142631
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.142631
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number81262
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: