Individual
RATHNA SREE MALLELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
2600 HUMES RD STE 100, JANESVILLE, WI 53545-0491
(608) 741-2117
(608) 758-5761
Mailing address
2600 HUMES RD STE 100, JANESVILLE, WI 53545-0491
(608) 741-2117
(608) 758-5761
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
64316-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194043554
BCBSWI
WI
05
—
1194043554
—
WI
01
—
K400258432-000054176
WI MEDICARE
WI
01
—
K400258434-00084908
WI MEDICARE
WI
01
—
MALLERAT
MERCYCARE INSURANCE
WI
Enumeration date
05/11/2010
Last updated
07/21/2022
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