Provider Demographics
NPI:1235128844
Name:RATHOUR, RAJENDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJENDRA
Middle Name:S
Last Name:RATHOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3201 S 16TH ST
Mailing Address - Street 2:ROOM 1000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4537
Mailing Address - Country:US
Mailing Address - Phone:414-389-3180
Mailing Address - Fax:414-645-8240
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:ROOM 1000
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4537
Practice Address - Country:US
Practice Address - Phone:414-389-3180
Practice Address - Fax:414-645-8240
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31847900Medicaid
WI732000009Medicare ID - Type Unspecified
WI31847900Medicaid