Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 21598 | WI |
N | 207X00000X | Orthopaedic Surgeon | 4301099576 | MI |
N | 207X00000X | Orthopaedic Surgeon | 48834 | CO |
N | 207X00000X | Orthopaedic Surgeon | PT12136 | ND |
N | 207XS0106X | Orthopaedic Hand Surgeon | 21598 | WI |
NPI | 1124182068 |
---|---|
Provider Name | Dr. Aftab A Ansari |
First Address | Kenosha, WI 53144 |
Second Address | Kenosha, WI 53144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30186800 | (05) | WI |
B51206 | (02) |