Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 52429 | WI |
NPI | 1023208592 |
---|---|
Provider Name | Dr. Abdul Mateen Khazi |
First Address | Wauwatosa, WI 53213-2504 |
Second Address | Wauwatosa, WI 53213-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 03/01/2022 |