Healthcare Provider Details

I. General information

NPI: 1245307362
Provider Name (Legal Business Name): AMB MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 W NORTH AVE SUITE 312
WAUWATOSA WI
53226-2315
US

IV. Provider business mailing address

10625 W NORTH AVE SUITE 312
WAUWATOSA WI
53226-2315
US

V. Phone/Fax

Practice location:
  • Phone: 414-443-9990
  • Fax: 414-443-9998
Mailing address:
  • Phone: 414-443-9990
  • Fax: 414-443-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NASIRA BEGUM
Title or Position: MANAGER
Credential:
Phone: 414-443-9990