Healthcare Provider Details

I. General information

NPI: 1003946534
Provider Name (Legal Business Name): RAJASHRI S MANOLI M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 W CAPITOL DR
MILWAUKEE WI
53222-1869
US

IV. Provider business mailing address

8500 W CAPITOL DR
MILWAUKEE WI
53222-1869
US

V. Phone/Fax

Practice location:
  • Phone: 414-463-9100
  • Fax:
Mailing address:
  • Phone: 414-463-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number20521-020
License Number StateWI

VIII. Authorized Official

Name: DR. RAJASHRI S MANOLI
Title or Position: OWNER
Credential: M.D.
Phone: 414-463-9100