Provider Demographics
NPI:1114144466
Name:BHOSEKAR, CHITRA SADASIWAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHITRA
Middle Name:SADASIWAN
Last Name:BHOSEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:2020 RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2300
Practice Address - Country:US
Practice Address - Phone:920-433-9920
Practice Address - Fax:920-433-9927
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50264207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114144466Medicaid
WI68086 0397Medicare PIN
WI1114144466Medicaid