Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 036-100521 | IL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 45561 | WI |
NPI | 1164483145 |
---|---|
Provider Name | Mehran Jabbarzadeh |
First Address | Milwaukee, WI 53215-2843 |
Second Address | Kenosha, WI 53142-7884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
325969551 | (05) | IL |
34539500 | (05) | WI |
I12487 | (02) |