Healthcare Provider Details

I. General information

NPI: 1093763260
Provider Name (Legal Business Name): SAILAJA KAMARAJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 OAK ST ALYCE & ELMORE KRAEMER CANCER CARE CENTER
WEST BEND WI
53095-3876
US

IV. Provider business mailing address

19805 AVONDALE DR
BROOKFIELD WI
53045-3770
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-8484
  • Fax: 414-805-4944
Mailing address:
  • Phone: 262-794-4090
  • Fax: 414-805-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number44909
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: