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General NPI Number Information
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NPI Number | 1457404535
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Entity Type | Individual
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Provider Name | GOVINDARAJU SUBRAMANI MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 480 N KOELLER ST OSHKOSH
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City | OSHKOSH
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State | WI
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Zip | 54902-4111
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Country | US
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Telephone | 920-236-3292
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Fax | 920-236-3295
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Provider Business Mailing Address
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Address Line | 319 WYLDEBERRY LN OSHKOSH
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City | OSHKOSH
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State | WI
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Zip | 54904-7679
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Country | US
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Telephone | 920-236-0661
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 28095-020
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License Number State | WI
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