Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 54656 | WI |
Y | 207VX0201X | Gynecologic Oncologist | 54656-20 | WI |
NPI | 1578628350 |
---|---|
Provider Name | Ali Mahdavi |
First Address | Janesville, WI 53548-2940 |
Second Address | Janesville, WI 53548-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 16/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1578628350 | (05) | WI |
1578628350 | BCBSWI (01) | WI |
H43185 | (02) | CA |
MAHDAALI | MERCYCARE INSURANCE (01) | WI |