Provider Demographics
NPI:1093763260
Name:KAMARAJU, SAILAJA (MD)
Entity Type:Individual
Prefix:
First Name:SAILAJA
Middle Name:
Last Name:KAMARAJU
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 1:19805 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3770
Mailing Address - Country:US
Mailing Address - Phone:262-794-4090
Mailing Address - Fax:414-805-4944
Practice Address - Street 1:1110 OAK ST
Practice Address - Street 2:ALYCE & ELMORE KRAEMER CANCER CARE CENTER
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3876
Practice Address - Country:US
Practice Address - Phone:262-334-8484
Practice Address - Fax:414-805-4944
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44909207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093763260Medicaid
WI34290100Medicaid
WI007265185Medicare ID - Type Unspecified
WI34290100Medicaid
WI736012338Medicare PIN
WI680861124Medicare PIN