Healthcare Provider Details

I. General information

NPI: 1518959329
Provider Name (Legal Business Name): MATHANGI R SEKHARAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10256 OLD GREEN BAY RD
PLEASANT PRAIRIE WI
53158-2814
US

IV. Provider business mailing address

103 S GREENLEAF ST STE A
GURNEE IL
60031-3380
US

V. Phone/Fax

Practice location:
  • Phone: 262-551-4240
  • Fax: 262-551-4245
Mailing address:
  • Phone: 847-623-5855
  • Fax: 847-623-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036089529
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4230
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: