Individual
RANJINI B GANDHAVADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2350 N LAKE DR, SUITE G01, MILWAUKEE, WI 53211-4528
(414) 291-1556
(414) 291-1557
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 291-1556
(414) 291-1557
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
22791-020
WI
2085R0203X
Therapeutic Radiology Physician
22791-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30456100
—
WI
01
—
920005883
RAILROAD MEDICARE
WI
Enumeration date
11/03/2005
Last updated
06/11/2012
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