Provider Demographics
NPI:1265428775
Name:VENUGOPALAN, RAMAKRISHNA P (MD)
Entity type:Individual
Prefix:
First Name:RAMAKRISHNA
Middle Name:P
Last Name:VENUGOPALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMA
Other - Middle Name:P
Other - Last Name:VENU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:252 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-1828
Mailing Address - Country:US
Mailing Address - Phone:262-767-6148
Mailing Address - Fax:262-767-6147
Practice Address - Street 1:252 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-1828
Practice Address - Country:US
Practice Address - Phone:262-767-6148
Practice Address - Fax:262-767-6147
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22143207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30307400Medicaid
WI30307400Medicaid
C65209Medicare UPIN
524450001Medicare ID - Type Unspecified