Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 72553-20 | WI |
NPI | 1003268343 |
---|---|
Provider Name | Mohammed Omer Ahmed Abdalla |
First Address | Milwaukee, WI 53226-3548 |
Second Address | Milwaukee, WI 53226-3548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2016 |
Last Update Date | 22/05/2020 |