Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 68978 | WI |
N | 208600000X | Surgeon | 68978 | WI |
Y | 2086S0129X | Vascular Surgeon | 68978 | WI |
NPI | 1104055839 |
---|---|
Provider Name | Dr. Abhishek Sundaram |
First Address | Grafton, WI 53024-9201 |
Second Address | Grafton, WI 53024-9201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 29/11/2021 |