Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036-138706 | IL |
N | 207V00000X | Obstetrician & Gynecologist | 72957-20 | WI |
N | 207VG0400X | Gynecologist | 206655 | LA |
N | 207VX0000X | Obstetrician | 206655 | LA |
NPI | 1043536477 |
---|---|
Provider Name | Kaneez Fatima Ali |
First Address | Milwaukee, WI 53278-8866 |
Second Address | Rockford, IL 61114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 28/05/2020 |