Provider Demographics
NPI:1811961527
Name:MURTHY, V S (MD)
Entity type:Individual
Prefix:
First Name:V
Middle Name:S
Last Name:MURTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VISHNUBHAKTA
Other - Middle Name:SHRINIVAS
Other - Last Name:MURTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:777
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-649-3530
Mailing Address - Fax:
Practice Address - Street 1:960 N 12TH ST
Practice Address - Street 2:STE 400
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-219-7653
Practice Address - Fax:414-219-7676
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22864207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30393700Medicaid
001640245Medicare PIN
WI30393700Medicaid
001604130Medicare PIN
001646515Medicare PIN
001660350Medicare PIN
001654475Medicare PIN