Healthcare Provider Details

I. General information

NPI: 1952393944
Provider Name (Legal Business Name): OMER AFZAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ANN STREET
WAUKESHA WI
53188
US

IV. Provider business mailing address

335 MAHN COURT
OAK CREEK WI
53154
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-6179
  • Fax: 262-542-6182
Mailing address:
  • Phone: 414-762-2020
  • Fax: 414-762-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number45209
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: