Provider Demographics
NPI:1740221910
Name:BHATTACHARJEE, SUMON (MD)
Entity Type:Individual
Prefix:MR
First Name:SUMON
Middle Name:
Last Name:BHATTACHARJEE
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 1:1305 W AMERICAN DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1993
Mailing Address - Country:US
Mailing Address - Phone:920-725-9373
Mailing Address - Fax:920-720-7392
Practice Address - Street 1:1305 W AMERICAN DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1993
Practice Address - Country:US
Practice Address - Phone:920-725-9373
Practice Address - Fax:920-720-7392
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46005207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34616300Medicaid
WI002571450Medicare ID - Type Unspecified
WI34616300Medicaid
I26199Medicare UPIN