Healthcare Provider Details

I. General information

NPI: 1568534824
Provider Name (Legal Business Name): SRIHARI R RAMANUJAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13133 N. PORT WASHINGTON ROAD SUITE G-16
MEQUON WI
53097
US

IV. Provider business mailing address

788 N. JEFFERSON STREET SUITE 300/ATTN. KAAREN BUTZEN
MILWAUKEE WI
53202
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-2500
  • Fax: 262-243-5395
Mailing address:
  • Phone: 414-272-8950
  • Fax: 414-272-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number46824
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: