Provider Demographics
NPI:1427032960
Name:MAZUMDAR, DEBESH CHANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBESH
Middle Name:CHANDRA
Last Name:MAZUMDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 N RIVERCENTER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-3978
Mailing Address - Country:US
Mailing Address - Phone:414-274-7520
Mailing Address - Fax:414-274-7525
Practice Address - Street 1:1575 N RIVERCENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3978
Practice Address - Country:US
Practice Address - Phone:414-274-7520
Practice Address - Fax:414-274-7525
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22721-020207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI302-86-900Medicaid
B54895Medicare UPIN
02-909Medicare ID - Type Unspecified