Provider Demographics
NPI:1922072248
Name:SINGH, SANJAY (MD)
Entity Type:Individual
Prefix:MR
First Name:SANJAY
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 DELAFIELD STREET
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3403
Mailing Address - Country:US
Mailing Address - Phone:262-542-0074
Mailing Address - Fax:262-542-2803
Practice Address - Street 1:1111 DELAFIELD STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3403
Practice Address - Country:US
Practice Address - Phone:262-542-0074
Practice Address - Fax:262-542-2803
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI24263207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB56640Medicare UPIN