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General NPI Number Information
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NPI Number | 1114995651
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Entity Type | Individual
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Provider Name | RAMA SHANKAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 403 E 1ST ST
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City | DIXON
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State | IL
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Zip | 61021-3116
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Country | US
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Telephone | 815-285-5579
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Fax | 815-285-5584
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Provider Business Mailing Address
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Address Line | 700 W VIRGINIA ST STE 305
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City | MILWAUKEE
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State | WI
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Zip | 53204-1549
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Country | US
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Telephone | 414-359-5740
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Fax | 866-842-7257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036-095468
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License Number State | IL
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