Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 56638-20 | WI |
NPI | 1003129958 |
---|---|
Provider Name | Amritha Chandrahasa Karkera |
First Address | Green Bay, WI 54311 |
Second Address | Green Bay, WI 54311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2010 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003129958 | (05) | WI |