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NPI Code Detail

MEDICARE: DR. TARIQ ELMADAWY

MEDICARE: DR. TARIQ ELMADAWY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6001237-15WI
2122300000XDentist2901601681MI

General Provider Information

NPI Number : 1164109336
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TARIQ ELMADAWY
Provider Business Mailing Address
First Line : 2480 MARINA CIR UNIT 502
Second Line :
City : ASHWAUBENON
State : WI
Zip : 54304-4877
Country : US
Telephone Number : 734-502-8196
Fax Number :
Provider Business Practice Location Address
First Line : 1551 PARK PL STE 300
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-1969
Country : US
Telephone Number : 920-332-6644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2023
Last Update Date : 01/27/2025

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Directions to “ DR. TARIQ ELMADAWY ” Practice Location

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