Provider Demographics
NPI:1255362299
Name:RAJAMANNAN, NALINI M (MD)
Entity type:Individual
Prefix:
First Name:NALINI
Middle Name:M
Last Name:RAJAMANNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4501
Mailing Address - Country:US
Mailing Address - Phone:920-451-4611
Mailing Address - Fax:855-827-3381
Practice Address - Street 1:703 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4501
Practice Address - Country:US
Practice Address - Phone:920-451-4611
Practice Address - Fax:855-827-3381
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103233207RC0000X
WI41806207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
002350204OtherMEDICARE ID
F16779Medicare UPIN