Healthcare Provider Details

I. General information

NPI: 1225487176
Provider Name (Legal Business Name): NORHAN MOHAMMED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 SUMMIT AVE
OCONOMOWOC WI
53066-3844
US

IV. Provider business mailing address

30 N GOULD ST STE R
SHERIDAN WY
82801-6317
US

V. Phone/Fax

Practice location:
  • Phone: 262-569-9400
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number65994
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30144301
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number65994
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: