Individual
SUJAN FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 W WISCONSIN AVE, DEPARTMENT OF RADIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Mailing address
9200 W WISCONSIN AVE, DEPARTMENT OF RADIOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
54297
WI
2085R0202X
Diagnostic Radiology Physician
ME115385
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008911900
—
FL
Enumeration date
07/16/2008
Last updated
06/25/2014
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