1588956197 NPI number — DR. SUDIP RINGWALA D.O.

Table of content: DR. SUDIP RINGWALA D.O. (NPI 1588956197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588956197 NPI number — DR. SUDIP RINGWALA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RINGWALA
Provider First Name:
SUDIP
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588956197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4906 39TH AVE
Provider Second Line Business Mailing Address:
ALLERGY AND ASTHMA CLINIC OF KENOSHA
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-203-5193
Provider Business Mailing Address Fax Number:
920-456-5590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4906 39TH AVE
Provider Second Line Business Practice Location Address:
ALLERGY AND ASTHMA CLINIC OF KENOSHA
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-203-5193
Provider Business Practice Location Address Fax Number:
920-456-5590
Provider Enumeration Date:
05/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  60091-21 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: AS0799140035 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1649202128 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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