Provider Demographics
NPI:1205126851
Name:DEKA, ANJAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANJAN
Middle Name:
Last Name:DEKA
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 1:9200 W WISCONSIN AVENUE
Mailing Address - Street 2:DIVISON OF CARDIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-5611
Mailing Address - Fax:414-456-6515
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 190
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8018
Practice Address - Country:US
Practice Address - Phone:470-639-6250
Practice Address - Fax:770-345-0712
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6745320207RC0000X
IL036.135578207RC0000X
GA82555207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1205126851Medicaid