| NPI | 1164637492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMAL SYED MUZAFFAR CEO 262-743-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 305S00000X Point of Service (Licence: WI 43819-020) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2019-04-10 |