Provider Demographics
NPI:1801449541
Name:JATRA LLC
Entity type:Organization
Organization Name:JATRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIDHWI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKERJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-406-1433
Mailing Address - Street 1:1771 RIVER OAKS CT
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7928
Mailing Address - Country:US
Mailing Address - Phone:913-406-1433
Mailing Address - Fax:715-845-5647
Practice Address - Street 1:410 DEWEY ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4715
Practice Address - Country:US
Practice Address - Phone:715-422-7755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty