Individual
SUDHAKAR BASETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
410 DEWEY ST, WISCONSIN RAPIDS, WI 54494-4715
(718) 920-9892
Mailing address
410 DEWEY ST, WISCONSIN RAPIDS, WI 54494-4715
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
83167-20
WI
Other
Enumeration date
09/27/2020
Last updated
10/01/2024
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