Provider Demographics
NPI:1972520823
Name:ANNE, VENKATA VIJAY K (MD)
Entity type:Individual
Prefix:DR
First Name:VENKATA VIJAY
Middle Name:K
Last Name:ANNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 070520
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-0520
Mailing Address - Country:US
Mailing Address - Phone:262-240-0841
Mailing Address - Fax:
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:SUITE 2015
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4537
Practice Address - Country:US
Practice Address - Phone:414-649-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45393207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH80901Medicare UPIN
WI000101671Medicare PIN