| NPI | 1558534313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLAHYAR JAZAYERI President/Owner 920-338-6868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology Maternal & Fetal Medicine (Licence: WI 44616020) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WI 44616020) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2009-12-04 |