Ramanuja R Manda, MD FACC FCCP

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

27743 Issued in WI

Practice address

6308 8TH Ave
Ste 3060
Kenosha, WI 53143-5082

Phone

(262) 656-8271

Fax

(262) 656-8255

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Phoenixc Healthcare, SC

  • Clinical Cardiac Electrophysiology Physician
  • Kenosha, WI
  • NPI 1821591710
  NPD
• Kenosha Pathology Consultants

  • Anatomic Pathology & Clinical Pathology Physician
  • Kenosha, WI
  • NPI 1790812857
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252972800000",
    "number": "1407830698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "STE 3060",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435082",
            "telephone_number": "262-656-8271",
            "fax_number": "262-656-8255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "address_2": "STE 3060",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435082",
            "telephone_number": "262-656-8271",
            "fax_number": "262-656-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDA",
        "first_name": "RAMANUJA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD FACC FCCP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2009-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "27743",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "WI",
            "license": "27743",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407830698",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30745100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sandra J. Malone, CSAC
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• Isaac D. W. Mansur, D.C.
• Emily Manteufel
• Natalie Ann Manwaring
• Kristin Marchese, MS

• All providers in Kenosha, WI
• Cardiovascular Disease Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.