Musunuru, Jagadeeswara Rao

Musunuru, Jagadeeswara Rao is an individual health care provider with primary practice located at 459 E 1St St , Fond Du Lac WI 54935-4505. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Musunuru, Jagadeeswara Rao can be contacted via phone (920) 929-3502.

Contact Information

Primary practice address
459 E 1St St Fond Du Lac WI 54935-4505
Phone: (920) 929-3502
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 23168 Wisconsin
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 14564 Nebraska

Profile Details

NPI number 1194940130
LBN Legal business name Musunuru, Jagadeeswara Rao
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 16th, 2007
Last updated Jan 22nd, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194940130 NPPES
Wisconsin MEDICAID 30356800

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