Provider Demographics
NPI:1588956197
Name:RINGWALA, SUDIP (DO)
Entity type:Individual
Prefix:DR
First Name:SUDIP
Middle Name:
Last Name:RINGWALA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2108
Mailing Address - Country:US
Mailing Address - Phone:920-203-5193
Mailing Address - Fax:262-657-4666
Practice Address - Street 1:4906 39TH AVE
Practice Address - Street 2:ALLERGY AND ASTHMA CLINIC OF KENOSHA
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:920-203-5193
Practice Address - Fax:920-456-5590
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAS0799140035207R00000X
WI60091-21207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1649202128Medicaid
WI1649202128Medicaid