Provider Demographics
NPI:1528039849
Name:RAO, SRIDHAR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SRIDHAR
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:MD, PHD
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2420
Mailing Address - Fax:414-456-6543
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2420
Practice Address - Fax:414-456-6543
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI55842-0202080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528039849Medicaid
WI736012276Medicare PIN
WI680861053Medicare PIN