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General NPI Number Information
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NPI Number | 1649387911
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Entity Type | Individual
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Provider Name | CHERUPPOLIL R SANTHOSH-KUMAR MD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1222 N 23RD ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-3171
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Country | US
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Telephone | 920-457-6800
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Fax | 920-457-3772
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Provider Business Mailing Address
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Address Line | 3301 W FOREST HOME AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-2843
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Country | US
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Telephone | 414-647-6326
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Fax | 414-671-8860
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 44563
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License Number State | WI
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