Provider Demographics
NPI:1891803862
Name:GIRIYAPPA, PRADEEP (MD)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:GIRIYAPPA
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:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-6212
Mailing Address - Fax:920-684-5548
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-9662
Practice Address - Country:US
Practice Address - Phone:920-320-6212
Practice Address - Fax:920-684-5548
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI16860979OtherWPS
WIF25392OtherCIGNA
WI31887OtherTOUCHPOINT
WI100003091OtherWEA
WI110176083OtherRAILROAD MEDICARE
WI31802400Medicaid
WI10112OtherNETWORK HEALTH PLAN
WI390806395002OtherCHAMPUS
WI10112OtherNETWORK HEALTH PLAN
WI38235-0008Medicare ID - Type Unspecified