1821475120 NPI number — MR. AMIN NAMAZI APNP

Table of content: MR. KEVIN LAMAR HAWKINS JR. (NPI 1831843713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821475120 NPI number — MR. AMIN NAMAZI APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAMAZI
Provider First Name:
AMIN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
APNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821475120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W193S8810 WIND CREST CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGO
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53150-7872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-217-3718
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 AMERICAN AVE.
Provider Second Line Business Practice Location Address:
PROHEALTH CARE WAUKESHA MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-5099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-928-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  5933-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: 5933-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)