Provider Demographics
NPI:1811305402
Name:SUNDARARAJAN, SAKTHI KUMAR (MD)
Entity type:Individual
Prefix:
First Name:SAKTHI
Middle Name:KUMAR
Last Name:SUNDARARAJAN
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 1:8701 W. WATERTOWN PLANK ROAD
Mailing Address - Street 2:HUB FOR COLLABORATIVE MEDICINE, 7TH FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3548
Mailing Address - Country:US
Mailing Address - Phone:414-955-0392
Mailing Address - Fax:414-955-0094
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-805-0812
Practice Address - Fax:414-805-0855
Is Sole Proprietor?:No
Enumeration Date:2014-07-26
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69564207R00000X
MA259956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1811305402Medicaid