Basic Information
| Provider Information | |||||||||
| NPI: | 1952569667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAMRA | ||||||||
| FirstName: | VIKRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 E CORCORAN AVE | ||||||||
| Address2: | 601 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532026121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105901498 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4025 N 92ND ST | ||||||||
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| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532221613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143585437 | ||||||||
| FaxNumber: | 4143585421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 60930 - 20 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.