Provider Demographics
NPI:1184724072
Name:PATIL, VEERANAGOUDA (MD)
Entity type:Individual
Prefix:
First Name:VEERANAGOUDA
Middle Name:
Last Name:PATIL
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 1:3150 GERSHWIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-5859
Mailing Address - Country:US
Mailing Address - Phone:920-391-6940
Mailing Address - Fax:920-391-4811
Practice Address - Street 1:2640 W POINT RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1344
Practice Address - Country:US
Practice Address - Phone:920-490-3790
Practice Address - Fax:920-490-3858
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI308102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31762200Medicaid
WI31762200Medicaid
WI500815Medicare ID - Type Unspecified