Provider Demographics
NPI:1457404535
Name:SUBRAMANI, GOVINDARAJU (MD)
Entity Type:Individual
Prefix:
First Name:GOVINDARAJU
Middle Name:
Last Name:SUBRAMANI
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 1:319 WYLDEBERRY LN
Mailing Address - Street 2:OSHKOSH
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7679
Mailing Address - Country:US
Mailing Address - Phone:920-236-0661
Mailing Address - Fax:
Practice Address - Street 1:480 N KOELLER ST
Practice Address - Street 2:OSHKOSH
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4111
Practice Address - Country:US
Practice Address - Phone:920-236-3292
Practice Address - Fax:920-236-3295
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28095-020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIBS0987252OtherDEA
WIBS0987252OtherDEA