Provider Demographics
NPI:1417953829
Name:RAJA, SHARATH C (MD)
Entity Type:Individual
Prefix:
First Name:SHARATH
Middle Name:C
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2600 N MAYFAIR RD STE 901
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1307
Mailing Address - Country:US
Mailing Address - Phone:414-774-3484
Mailing Address - Fax:414-778-3445
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:STE 901
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1307
Practice Address - Country:US
Practice Address - Phone:414-774-3484
Practice Address - Fax:414-778-3445
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
WI43132207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10664286OtherCAQH
WI34098400Medicaid
WI43132OtherWI STATE LICENSE
000000172683OtherAMERICAN ACADEMY OF OPHTHALMOLOGY
000000172683OtherAMERICAN ACADEMY OF OPHTHALMOLOGY