Healthcare Provider Details

I. General information

NPI: 1700803541
Provider Name (Legal Business Name): QAMARUDDIN QAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD 1ST FLOOR
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

3720 DEER RUN CT
MANITOWOC WI
54220-1668
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8100
  • Fax:
Mailing address:
  • Phone: 920-684-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number38877
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: