Provider Demographics
NPI:1356392252
Name:RAWAL, ASHISH M (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:M
Last Name:RAWAL
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 1:900 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1864
Mailing Address - Country:US
Mailing Address - Phone:608-877-3419
Mailing Address - Fax:608-231-3430
Practice Address - Street 1:900 RIDGE ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1864
Practice Address - Country:US
Practice Address - Phone:608-877-3419
Practice Address - Fax:608-231-3430
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62023-20207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110642Medicaid
IL036110642Medicaid
IL431660Medicare ID - Type UnspecifiedGROUP NUMBER
WIK400142863Medicare PIN