=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124020870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAMAYUN SAEED MIAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1385 W MAIN AVE
-----------------------------------------------------
City | DE PERE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54115-9366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-433-9400
-----------------------------------------------------
Fax | 920-455-9409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1385 W MAIN AVE
-----------------------------------------------------
City | DE PERE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54115-9366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-433-9400
-----------------------------------------------------
Fax | 920-433-9409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 46435
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------