Ajit B Divgi, MD

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

21657 Issued in WI

Practice address

3200 Pleasant Valley Rd
Kraemer Cancer Care Center
West Bend, WI 53095-9274

Phone

(262) 836-7200

Fax

(262) 334-8484

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1568453223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 PLEASANT VALLEY RD",
            "address_2": "KRAEMER CANCER CARE CENTER",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959274",
            "telephone_number": "262-836-7200",
            "fax_number": "262-334-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 PLEASANT VALLEY RD",
            "address_2": "KRAEMER CANCER CARE CENTER",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959274",
            "telephone_number": "262-836-7200",
            "fax_number": "262-334-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVGI",
        "first_name": "AJIT",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WI",
            "license": "21657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1568453223",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Divine Home Health Care LLC
• Loreal Dolar
• Marie A Dominguez, M.D.
• Stephen M Domres, D.D.S.
• Scott W Donovan, MD

• Hematology & Oncology Physician in West Bend, WI
• Providers in West Bend, WI by specialty
• Hematology & Oncology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; 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.