Healthcare Provider Details

I. General information

NPI: 1508123787
Provider Name (Legal Business Name): NGII N TAZEH M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NGII NKHANGLEFACK TAZEH

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

515 22ND AVE
MONROE WI
53566-1569
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2222
  • Fax:
Mailing address:
  • Phone: 608-628-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number61264
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: