Provider Demographics
NPI:1346413861
Name:DUDHWALA, VIRAJ V (MD)
Entity Type:Individual
Prefix:
First Name:VIRAJ
Middle Name:V
Last Name:DUDHWALA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:725 AMERICAN AVE
Mailing Address - Street 2:ROOM 2036
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-928-5400
Mailing Address - Fax:262-928-6140
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:ROOM 2036 PROHEALTH CARE MEDICAL ASSOCIATES INC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-5400
Practice Address - Fax:262-928-6140
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI56024207R00000X
WI56024-20208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1346413861Medicaid
WI68375Medicare PIN