Healthcare Provider Details

I. General information

NPI: 1679418131
Provider Name (Legal Business Name): AKHIL BHARADWAZ GANGULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 09/04/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASCENSION COLUMBIA ST. MARY'S HOSPITAL, 2301 N. LAKE DRIVE
MILWAUKEE WI
53211
US

IV. Provider business mailing address

ASCENSION COLUMBIA ST. MARY'S HOSPITAL, 2301 N. LAKE DRIVE
MILWAUKEE WI
53211
US

V. Phone/Fax

Practice location:
  • Phone: 414-585-1000
  • Fax: 414-585-1113
Mailing address:
  • Phone: 414-585-1000
  • Fax: 414-585-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: