Healthcare Provider Details

I. General information

NPI: 1457086019
Provider Name (Legal Business Name): MOHAMMAD ASHAAUDDIN FARAZ KHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W CHAMBERS ST
MILWAUKEE WI
53210-1650
US

IV. Provider business mailing address

5000 W CHAMBERS ST
MILWAUKEE WI
53210-1650
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2000
  • Fax:
Mailing address:
  • Phone: 414-447-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81900-21
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number81900-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: