Individual
RAMA VAIDYANATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2514 S 102ND ST, STE. 160, WEST ALLIS, WI 53227-2142
(414) 255-0300
(414) 543-9601
Mailing address
PO BOX 639295 DEPT 93394, CINCINNATI, OH 45263-9295
(248) 842-6600
(855) 618-6655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
47214
WI
207R00000X
Internal Medicine Physician
Primary
T9267
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34566100
—
WI
Enumeration date
02/23/2006
Last updated
08/19/2024
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