Individual
DR. SUBBANNA JAYAPRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3811 SPRING ST, SUITE 301, RACINE, WI 53405-1667
(262) 687-6262
(262) 687-6261
Mailing address
7401 LATIGO CIR, FRANKSVILLE, WI 53126-9468
(262) 886-6252
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
O27676
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314772200
—
WI
Enumeration date
10/07/2005
Last updated
07/08/2007
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