Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 52208 | WI |
N | 207RA0201X | Internist - Allergy & Immunology | 52208 | WI |
N | 2080P0201X | Pediatric Allergist | 52208 | WI |
NPI | 1326084534 |
---|---|
Provider Name | Dr. Ravi Viswanathan |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53717-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 26/10/2021 |