Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 65042 | WI |
NPI | 1053559559 |
---|---|
Provider Name | Dr. Suhaib Kazmouz |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-3619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 03/08/2020 |