Provider Demographics
NPI:1801887914
Name:RAJKUMAR, SRUTHA P (MD)
Entity type:Individual
Prefix:DR
First Name:SRUTHA
Middle Name:P
Last Name:RAJKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2323 N LAKE DR
Mailing Address - Street 2:BEHAVIORAL MEDICINE, 7TH FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4508
Mailing Address - Country:US
Mailing Address - Phone:414-291-1620
Mailing Address - Fax:414-291-5969
Practice Address - Street 1:2323 N LAKE DR
Practice Address - Street 2:BEHAVIORAL MEDICINE, 7TH FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-291-1620
Practice Address - Fax:414-291-5969
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33105-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31867800Medicaid
WI000384110Medicare PIN
WI000500108Medicare PIN
WI001584278Medicare ID - Type Unspecified
WI31867800Medicaid