Provider Demographics
NPI:1083961528
Name:VECHURETTU RAJ, RENJU (MD)
Entity Type:Individual
Prefix:
First Name:RENJU
Middle Name:
Last Name:VECHURETTU RAJ
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:NEOPLASTIC DISEASES HOSPITALIST
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6800
Mailing Address - Fax:414-805-6805
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:NEOPLASTIC DISEASES HOSPITALIST
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6800
Practice Address - Fax:414-805-6805
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA40893207R00000X
WI62630207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1083961528Medicaid