Provider Demographics
NPI:1033187216
Name:SOMARAJU, VIJAYA (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:SOMARAJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:1905 E. HUEBBE PARKWAY
Practice Address - Street 2:BELOIT CLINIC
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2240
Practice Address - Fax:608-363-7374
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097724207RI0200X
WI63995-20207RI0200X
IL036-097724207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097724Medicaid
IL036097724Medicaid
IL036097724Medicaid
IL07215036OtherBCBS
ILIL01CGOtherJOHN DEERE
IL110224691Medicare ID - Type UnspecifiedRR INDIVIDUAL #
IL639810Medicare ID - Type UnspecifiedMEDICARE
ILL78958Medicare ID - Type UnspecifiedINDIVIDUAL #
IL800880Medicare ID - Type UnspecifiedGROUP #