Provider Demographics
NPI:1891948089
Name:UTTAM, ASHWIN (DO)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:
Last Name:UTTAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 AMERICAN AVE RM 2036
Mailing Address - Street 2:PHC HOSPITALIST PROGRAM
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-928-5400
Mailing Address - Fax:
Practice Address - Street 1:725 AMERICAN AVE RM 2036
Practice Address - Street 2:PHC HOSPITALIST PROGRAM
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5629721208M00000X
WI56297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1891948089Medicaid
683750695Medicare PIN