Healthcare Provider Details

I. General information

NPI: 1114205101
Provider Name (Legal Business Name): ADNAN ZAIDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 E SUMNER ST
HARTFORD WI
53027-2684
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-670-4000
  • Fax:
Mailing address:
  • Phone: 262-670-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number60217
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number60217
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: