Provider Demographics
NPI:1447227129
Name:SANTHARAM, RAJESH (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:SANTHARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY STE 1080
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3689
Mailing Address - Country:US
Mailing Address - Phone:414-908-6601
Mailing Address - Fax:414-385-2980
Practice Address - Street 1:1033 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3442
Practice Address - Country:US
Practice Address - Phone:414-454-0600
Practice Address - Fax:414-454-0971
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42154207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34100500Medicaid
WI34100500Medicaid