Provider Demographics
NPI:1073743076
Name:HOLENARASIPURA RAJANNA, HEMALATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:HEMALATHA
Middle Name:
Last Name:HOLENARASIPURA RAJANNA
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 1:11101 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1133
Mailing Address - Country:US
Mailing Address - Phone:262-646-1391
Mailing Address - Fax:262-646-1393
Practice Address - Street 1:11101 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-1133
Practice Address - Country:US
Practice Address - Phone:262-646-1391
Practice Address - Fax:262-646-1393
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI556522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1073743076Medicaid