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General NPI Number Information
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NPI Number | 1104009240
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Entity Type | Organization
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Legal Business Name | AFTAB A ANSARI, M.D., S.C.
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 3535 30TH AVE SUITE 101B
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City | KENOSHA
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State | WI
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Zip | 53144-1632
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Country | US
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Telephone | 262-652-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 30TH AVE SUITE 101B
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City | KENOSHA
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State | WI
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Zip | 53144-1632
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Country | US
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Telephone | 262-652-4878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AFTAB A ANSARI
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Credential | M.D., S.C.
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Telephone | 262-652-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 21598
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License Number State | WI
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