Individual
JAGADEESWARA RAO MUSUNURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3502
Mailing address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3502
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
14564
NE
2084P0800X
Psychiatry Physician
Primary
23168
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30356800
—
WI
Enumeration date
04/16/2007
Last updated
01/22/2008
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