Healthcare Provider Details

I. General information

NPI: 1003569328
Provider Name (Legal Business Name): MEDZONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 W NORTH AVE STE 150
MILWAUKEE WI
53205-1101
US

IV. Provider business mailing address

1919 W NORTH AVE STE 150
MILWAUKEE WI
53205-1101
US

V. Phone/Fax

Practice location:
  • Phone: 414-395-0009
  • Fax:
Mailing address:
  • Phone: 414-395-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARWAN ALY
Title or Position: OWNER
Credential:
Phone: 414-395-0009