DR. KUMAR R SANNAGOWDARA (NPI# 1063779601) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063779601 |
| Entity Type | Individual |
| Full Name | DR. KUMAR R SANNAGOWDARA |
| Credential | M D |
| Practice Address |
12500 Aurora Dr Pleasant Prairie WI 53158-1227 |
| Mailing Address |
3301 W Forest Home Ave Milwaukee WI 53215-2843 |
| Practice Telephone | 2628575000 |
| Practice Fax Number | 2628575001 |
| Mailing Telephone | 2628575000 |
| Mailing Fax Number | 2628575001 |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2020-10-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
57263 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1063779601 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9000 W Wisconsin Ave, Pediatric Neurology, Milwaukee, WI 532264874 | 4142663464 | 4142663466 |
| Street Address |
12500 AURORA DR |
| City | PLEASANT PRAIRIE |
| State | WI |
| Zip Code | 53158-1227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336189588 | Brian G Sapp | Pediatrics | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2006-06-07 |
| 1831726488 | Alexis J Mckeever | Physician Assistant | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2020-03-24 |
| 1154805836 | Jacob Michael Perotto | Physical Therapist | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2018-09-19 |
| 1295244846 | Sean M Seiler | Physical Therapist | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2017-09-27 |
| 1831646496 | Lauren D Toner | Physical Therapist | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2016-09-01 |
| 1831643212 | Jessica L Hrncar | Physical Therapist | 12500 Aurora Dr, Pleasant Prairie, WI 53158 | 2016-08-15 |
| 1992177976 | Dennis M Orellana Bonilla | Nurse Practitioner | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2015-10-29 |
| 1154797306 | Michael James Mulroy | Physical Therapist | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2015-08-11 |
| 1538560248 | Louis J Cohn | Physical Therapist | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2014-09-12 |
| 1497011852 | Walter J Kim | Orthopaedic Surgery | 12500 Aurora Dr, Pleasant Prairie, WI 53158 | 2012-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497393516 | Aurora Surgery Centers, LLC | Clinic/Center | 12500 Aurora Drive, Pleasant Prairie, WI 53158 | 2019-12-19 |
| 1770144297 | Jill Plaisted | Counselor | 8503 75th Street, Suite A, Pleasant Prairie, WI 53158 | 2019-06-25 |
| 1427593847 | Douglas Marion Mcdaniel | Physical Therapy Assistant | 5932 85th St, Pleasant Prairie, WI 53158 | 2016-12-20 |
| 1477095602 | Molly Weber | Speech-Language Pathologist | 8717 82nd St, Apartment 109, Pleasant Prairie, WI 53158 | 2016-11-04 |
| 1568919165 | Nicole Taylor | Specialist/Technologist | 9321 8th Avenue, Pleasant Prairie, WI 53158 | 2016-09-01 |
| 1578980165 | Forefront Dermatology, S.c. | Dermatology | 9020 76th St, Suite E, Pleasant Prairie, WI 53158 | 2014-03-21 |
| 1750603130 | Shelley L Johnson | Nurse Practitioner | 9697 Saint Catherines Dr # 300, Pleasant Prairie, WI 53158 | 2010-02-25 |
| 1194054981 | Jennifer S Stevens | Behavioral Analyst | 10450 72nd Ave, Pleasant Prairie, WI 53158 | 2009-12-08 |
| 1932273398 | Pamela Anderson | Registered Nurse | 11202 79 Street, Pleasant Prairie, WI 53158 | 2006-11-20 |
| 1033205562 | Holly Seidman | Pharmacist | 1309 110th Street, Pleasant Prairie, WI 53158 | 2006-10-04 |
| Find all providers in zip 53158 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376963694 | Shannon C Pollock | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2014-04-25 |
| 1972947224 | Samuel J Adams | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226 | 2013-04-17 |
| 1699036129 | Alexandria Lynn Lutley | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2012-05-31 |
| 1942597356 | Lileth Joy Mondok | Psychiatry & Neurology | 9000 W Wisconsin Avenue, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2011-07-06 |
| 1144532052 | Raquel Farias-moeller | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2010-07-08 |
| 1801002092 | Delphin Sallowm | Psychiatry & Neurology | 9000 W Wisconsin Ave, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2007-05-15 |
| 1659443620 | Dorota Halina Telega | Psychiatry & Neurology | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2006-11-14 |
| 1063592301 | Sergio Facchini | Psychiatry & Neurology | 600 Highland Ave, Madison, WI 53792-0001 | 2006-10-17 |
| 1003912346 | Richard V Colan | Psychiatry & Neurology | 8825 S Howell Ave, Suite 101, Oak Creek, WI 53154-3760 | 2006-09-15 |
| 1053335513 | Hema U Patel | Psychiatry & Neurology | 9000 W Wisconsin Ave, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2006-07-27 |
| Find all providers with the same taxonomy | ||||
| City | PLEASANT PRAIRIE |
| Zip Code | 53158 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.