Provider Demographics
NPI:1639279383
Name:HANMIAH, RAJESHWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESHWAR
Middle Name:
Last Name:HANMIAH
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 1:309 N BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-2127
Mailing Address - Country:US
Mailing Address - Phone:715-526-2111
Mailing Address - Fax:715-526-9174
Practice Address - Street 1:309 N BARTLETT ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-2127
Practice Address - Country:US
Practice Address - Phone:715-526-2111
Practice Address - Fax:715-526-9174
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37374207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32192600Medicaid
WI32192600Medicaid