Provider Demographics
NPI:1114995651
Name:SHANKAR, RAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMA
Middle Name:
Last Name:SHANKAR
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 1:700 W VIRGINIA ST
Mailing Address - Street 2:STE 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1549
Mailing Address - Country:US
Mailing Address - Phone:414-359-5740
Mailing Address - Fax:866-842-7257
Practice Address - Street 1:403 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3116
Practice Address - Country:US
Practice Address - Phone:815-285-5579
Practice Address - Fax:815-285-5584
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095468207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095468Medicaid
ILL75800Medicare PIN