Healthcare Provider Details

I. General information

NPI: 1750776266
Provider Name (Legal Business Name): SURAIYA AFROZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

IV. Provider business mailing address

1650 S 41ST ST
MANITOWOC WI
54220-7316
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-5241
  • Fax:
Mailing address:
  • Phone: 920-320-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number73784
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: