Individual
THULASIRAMAN P RAVICHANDRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2025 W OKLAHOMA AVE, SUITE 120, MILWAUKEE, WI 53215-4455
(414) 382-8960
(414) 382-8975
Mailing address
2025 W OKLAHOMA AVE, SUITE 120, MILWAUKEE, WI 53215-4455
(414) 382-8960
(414) 382-8975
Taxonomy
Speciality
Code
Description
License number
State
2084D0003X
Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
38984-20
WI
2084N0400X
Neurology Physician
Primary
38984-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130020975
RAILROAD MEDICARE
WI
05
—
32352600
—
WI
Enumeration date
05/24/2006
Last updated
03/11/2020
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