Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 64809-20 | WI |
N | 208200000X | Surgeon | 64809 | WI |
N | 208600000X | Surgeon | 64809 | WI |
N | 208800000X | Urologist | 64809 | WI |
NPI | 1376093716 |
---|---|
Provider Name | Talal M Al-Qaoud |
First Address | Madison, WI 53703-3471 |
Second Address | Madison, WI 53703-3471 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2016 |
Last Update Date | 22/12/2020 |