Healthcare Provider Details

I. General information

NPI: 1689670754
Provider Name (Legal Business Name): IMRAN K NIAZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W KK RIVER PKWY STE 305
MILWAUKEE WI
53215-3660
US

IV. Provider business mailing address

2901 W KK RIVER PKWY STE 305
MILWAUKEE WI
53215-3660
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-6070
  • Fax: 414-645-6354
Mailing address:
  • Phone: 414-645-6070
  • Fax: 414-645-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number26591
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: