Healthcare Provider Details

I. General information

NPI: 1710184080
Provider Name (Legal Business Name): SYEDA QUDSIA-FATIMA KHALID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYEDA QUDSIA FATIMA

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 S HOWELL AVE
OAK CREEK WI
53154-8344
US

IV. Provider business mailing address

3100 WILLIAMS BLVD
KENNER LA
70065-4505
US

V. Phone/Fax

Practice location:
  • Phone: 414-764-5726
  • Fax: 414-764-6954
Mailing address:
  • Phone: 504-443-1744
  • Fax: 504-684-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64003
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: