Active NPI
Aykarethu O Mammen, MD
- Surgery Physician
- Cedarburg, WI
National Provider Identifier
1417993791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 20052
- Practice address
- 4922 Columbia Rd
Cedarburg, WI 53012-9188 - Phone
- (262) 375-2829
- Fax
- (262) 375-8513
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20052 | WI | Primary |
Addresses
Primary practice location
4922 Columbia Rd
Cedarburg, WI 53012-9188
Mailing address
4922 Columbia Rd
Cedarburg, WI 53012-9188
Phone (262) 375-2829
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31155700 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20052 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417993791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4922 COLUMBIA RD",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530129188",
"telephone_number": "262-375-2829",
"fax_number": "262-375-8513"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4922 COLUMBIA RD",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530129188",
"telephone_number": "262-375-2829",
"fax_number": "262-375-8513"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMMEN",
"first_name": "AYKARETHU",
"middle_name": "O",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "20052",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31155700",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedarburg, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.