Healthcare Provider Details

I. General information

NPI: 1164043097
Provider Name (Legal Business Name): AKM ABUHIYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MCMILLEN ST
FORT ATKINSON WI
53538-1233
US

IV. Provider business mailing address

500 MCMILLEN ST
FORT ATKINSON WI
53538-1233
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-5571
  • Fax:
Mailing address:
  • Phone: 920-563-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82334-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: