Provider Demographics
NPI:1356395552
Name:AGNI, GUIRISH A (MD)
Entity type:Individual
Prefix:
First Name:GUIRISH
Middle Name:A
Last Name:AGNI
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 1:1808 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-250-1497
Mailing Address - Fax:608-250-1384
Practice Address - Street 1:225 CHURCH ST
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-1801
Practice Address - Country:US
Practice Address - Phone:608-877-2700
Practice Address - Fax:608-877-2726
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36272-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32132000Medicaid
WI4712OtherDEAN HEALTH INSURANCE
WI32132000Medicaid
WIG06134Medicare UPIN
WI110116681Medicare PIN