Provider Demographics
NPI:1760668529
Name:RAMAIAH, SHOBHA (MD)
Entity Type:Individual
Prefix:
First Name:SHOBHA
Middle Name:
Last Name:RAMAIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 SHORE DR
Mailing Address - Street 2:PO BOX 18
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4291
Mailing Address - Country:US
Mailing Address - Phone:715-735-7421
Mailing Address - Fax:
Practice Address - Street 1:3130 SHORE DR
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4291
Practice Address - Country:US
Practice Address - Phone:715-735-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34971700Medicaid
WI34971700Medicaid