Basic Information
| Provider Information | |||||||||
| NPI: | 1093763260 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAMARAJU | ||||||||
| FirstName: | SAILAJA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19805 AVONDALE DR | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530453770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627944090 | ||||||||
| FaxNumber: | 4148054944 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 OAK ST | ||||||||
| Address2: | ALYCE & ELMORE KRAEMER CANCER CARE CENTER | ||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530953876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623348484 | ||||||||
| FaxNumber: | 4148054944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 10/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 44909 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1093763260 | 05 | WI | MEDICAID | 34290100 | 05 | WI | MEDICAID |