Healthcare Provider Details

I. General information

NPI: 1740241793
Provider Name (Legal Business Name): RAED A HAMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 W CAPITOL DR SUITE 202B
MILWAUKEE WI
53222-1869
US

IV. Provider business mailing address

PO BOX 639
THIENSVILLE WI
53092-0639
US

V. Phone/Fax

Practice location:
  • Phone: 414-461-1133
  • Fax: 414-461-1156
Mailing address:
  • Phone: 414-247-9005
  • Fax: 414-247-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number46321
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number46321020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: