Healthcare Provider Details

I. General information

NPI: 1275589293
Provider Name (Legal Business Name): NAGARJUN RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAYASAM K NAGARJUN RAO MD

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE DEPARTMENT OF PATHOLOGY
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE DEPARTMENT OF PATHOLOGY
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-8442
  • Fax: 414-805-8444
Mailing address:
  • Phone: 414-805-8442
  • Fax: 414-805-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number42264-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: