Healthcare Provider Details

I. General information

NPI: 1043465263
Provider Name (Legal Business Name): AHMED JAVED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N 12TH ST
MILWAUKEE WI
53205-2591
US

IV. Provider business mailing address

PO BOX 735036
CHICAGO IL
60673-5036
US

V. Phone/Fax

Practice location:
  • Phone: 414-966-3030
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number56452-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: