Healthcare Provider Details

I. General information

NPI: 1568635589
Provider Name (Legal Business Name): NAUMAN KHURSHID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 11/03/2023
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

1 SEAGATE # 800
TOLEDO OH
43604-1558
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6667
  • Fax: 608-417-6364
Mailing address:
  • Phone: 419-291-3604
  • Fax: 419-479-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number57043
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number57043
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35.091410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: