MEDICARE: DR. KHAZI A MUQEET M.D

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
1	208D00000X	General Practice Physician	49769020	WI
2	2084P0800X	Psychiatry Physician	49769020	WI

General Provider Information

NPI Number	:	1841371234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHAZI A MUQEET M.D

Provider Business Mailing Address
First Line	:	14925 W SAN MATEO DR
Second Line	:
City	:	NEW BERLIN
State	:	WI
Zip	:	53151-4348
Country	:	US
Telephone Number	:	414-433-1668
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 W WATERTOWN PLANK RD
Second Line	:	DEPT OF PYCHIATRY
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3548
Country	:	US
Telephone Number	:	414-456-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/03/2009

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