Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 66489 | WI |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | R2994 | KY |
Y | 2081P2900X | Pain Medicine | 66489 | WI |
NPI | 1245599760 |
---|---|
Provider Name | Vittal Ramachandra Nagar |
First Address | Saint Croix Falls, WI 54024-4117 |
Second Address | Saint Croix Falls, WI 54024-4117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2012 |
Last Update Date | 15/01/2021 |