Provider Demographics
NPI:1063489615
Name:TUMULURI, RAMAGOPAL J (MD)
Entity Type:Individual
Prefix:
First Name:RAMAGOPAL
Middle Name:J
Last Name:TUMULURI
Suffix:
Gender:M
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:PO BOX 2040
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53201-2040
Mailing Address - Country:US
Mailing Address - Phone:414-649-3370
Mailing Address - Fax:414-649-3278
Practice Address - Street 1:18200 W CAPITOL DR STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-1446
Practice Address - Country:US
Practice Address - Phone:262-444-5148
Practice Address - Fax:262-444-5457
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39301207RC0000X
WI39301020207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32493500Medicaid
WI32493500Medicaid
003004130Medicare PIN
003060350Medicare PIN
G88216Medicare UPIN
003040245Medicare PIN
003054475Medicare PIN