1366529901 NPI number — DR. AHMAD Y HAFFAR MD

Table of content: DR. AHMAD Y HAFFAR MD (NPI 1366529901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366529901 NPI number — DR. AHMAD Y HAFFAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAFFAR
Provider First Name:
AHMAD
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366529901
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 ROOSEVELT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54151-1043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-724-6377
Provider Business Mailing Address Fax Number:
715-251-1681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3475 OMRO RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
OSHKOSH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54904-7125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-236-0991
Provider Business Practice Location Address Fax Number:
920-236-0993
Provider Enumeration Date:
11/01/2006

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: 2084N0400X , with the licence number:  23069 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21300900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30348500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com