Organization
SUBBANNA JAYAPRAKASH, M.D., S.C.
Active
Other names
Rehabilitation Physicians of Racine
Organization subpart
No
Provider details
NPI number
Authorized official
SUBBANNA JAYAPRAKASH M.D. (OWNER)
(262) 598-1001
Entity
Organization
Contact information
Practice address
6015 DURAND AVE, 500, RACINE, WI 53406-5089
(262) 598-1001
Mailing address
6015 DURAND AVE, 500, RACINE, WI 53406-5089
(262) 598-1001
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
27676
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31477200
—
WI
05
—
32783300
—
WI
Enumeration date
02/15/2006
Last updated
08/22/2020
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