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General NPI Number Information
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NPI Number | 1104921766
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Entity Type | Individual
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Provider Name | KHALID I CHAUDHRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 459 E 1ST ST
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City | FOND DU LAC
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State | WI
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Zip | 54935-4505
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Country | US
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Telephone | 920-929-3500
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Fax | 920-929-3129
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Provider Business Mailing Address
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Address Line | 1351 ONTARIO RD
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City | GREEN BAY
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State | WI
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Zip | 54311-8302
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Country | US
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Telephone | 920-328-1220
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Fax | 920-469-7213
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 66397
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 228976
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License Number State | NY
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