Provider Demographics
NPI:1003946534
Name:RAJASHRI S MANOLI M.D.
Entity Type:Organization
Organization Name:RAJASHRI S MANOLI M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJASHRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-463-9100
Mailing Address - Street 1:8500 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1869
Mailing Address - Country:US
Mailing Address - Phone:414-463-9100
Mailing Address - Fax:
Practice Address - Street 1:8500 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1869
Practice Address - Country:US
Practice Address - Phone:414-463-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20521-020207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30102500Medicaid
WIB54809Medicare UPIN
WI30102500Medicaid