Provider Demographics
NPI:1356376966
Name:RINGWALA, KIRTIDA N (MD)
Entity type:Individual
Prefix:DR
First Name:KIRTIDA
Middle Name:N
Last Name:RINGWALA
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 1:10 E IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901
Mailing Address - Country:US
Mailing Address - Phone:920-236-3214
Mailing Address - Fax:920-236-3217
Practice Address - Street 1:10 E IRVING AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901
Practice Address - Country:US
Practice Address - Phone:920-236-3214
Practice Address - Fax:920-236-3217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24413020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI03453200Medicaid
B56069Medicare UPIN
WI03453200Medicaid