Provider Demographics
NPI:1154616795
Name:BISWAS, ASHVINI VARADHI
Entity type:Individual
Prefix:DR
First Name:ASHVINI
Middle Name:VARADHI
Last Name:BISWAS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ASHVINI
Other - Middle Name:
Other - Last Name:VARADHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10400 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7884
Mailing Address - Country:US
Mailing Address - Phone:262-948-5600
Mailing Address - Fax:262-948-5828
Practice Address - Street 1:10400 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7884
Practice Address - Country:US
Practice Address - Phone:262-948-5600
Practice Address - Fax:262-948-5828
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125059150208000000X
WI65892207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100062488Medicaid