Provider Demographics
NPI:1477740009
Name:RAY, ERIK SANDHU (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:SANDHU
Last Name:RAY
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 1:2500 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8735
Mailing Address - Country:US
Mailing Address - Phone:920-739-5642
Mailing Address - Fax:920-202-8236
Practice Address - Street 1:2500 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8735
Practice Address - Country:US
Practice Address - Phone:920-739-5642
Practice Address - Fax:920-202-8236
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD600203592085R0202X
WI67407-202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA292190OtherL&I PROVIDER ID
WA292196OtherL&I PROVIDER ID
WA1091880Medicaid
WA292192OtherL&I PROVIDER ID
WA292192OtherL&I PROVIDER ID
WAG8924307Medicare PIN
WA292190OtherL&I PROVIDER ID
WA1091880Medicaid