Individual
SHARATH C RAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 N MAYFAIR RD, STE 901, MILWAUKEE, WI 53226-1307
(414) 774-3484
(414) 778-3445
Mailing address
2600 N MAYFAIR RD STE 901, MILWAUKEE, WI 53226-1307
(414) 774-3484
(414) 778-3445
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
43132
WI
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
43132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000172683
AMERICAN ACADEMY OF OPHTHALMOLOGY
—
01
—
10664286
CAQH
—
05
—
34098400
—
WI
01
—
43132
WI STATE LICENSE
WI
Enumeration date
06/22/2005
Last updated
03/07/2023
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