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General NPI Number Information
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NPI Number | 1831371442
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Entity Type | Organization
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Legal Business Name | RAM K MITTAL MD SC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 902 MILWAUKEE AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-2118
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Country | US
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Telephone | 414-762-3910
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Fax | 414-762-9694
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Provider Business Mailing Address
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Address Line | 902 MILWAUKEE AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-2118
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Country | US
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Telephone | 414-762-3910
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Fax | 414-762-9694
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Authorized Official
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Title or Position | OWNER
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Name | RAM K MITTAL
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Credential | MD
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Telephone | 414-762-3910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20701
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License Number State | WI
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