Provider Demographics
NPI:1952569667
Name:BAMRA, VIKRAM
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:BAMRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 E CORCORAN AVE
Mailing Address - Street 2:601
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6121
Mailing Address - Country:US
Mailing Address - Phone:510-590-1498
Mailing Address - Fax:
Practice Address - Street 1:4025 N 92ND ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1613
Practice Address - Country:US
Practice Address - Phone:414-358-5437
Practice Address - Fax:414-358-5421
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60930 - 202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology