Basic Information
| Provider Information | |||||||||
| NPI: | 1568769099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIDARI | ||||||||
| FirstName: | SHARATCHANDRA | ||||||||
| MiddleName: | SUBHASCHANDRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 164 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543032728 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2845 GREENBRIER RD | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543116519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202884848 | ||||||||
| FaxNumber: | 9202884956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2011 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085H0002X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Hospice and Palliative Medicine | 2085N0700X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0202X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0203X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0205X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085U0001X | ME 106929 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | 66290 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.