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General NPI Number Information
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NPI Number | 1285968040
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Entity Type | Organization
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Legal Business Name | F TONDKAR LLC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 5310 W. CAPITAL DR. STE 102
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City | MILWAUKEE
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State | WI
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Zip | 53216-2264
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Country | US
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Telephone | 262-751-7496
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 W CAPITOL DR STE 102
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City | MILWAUKEE
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State | WI
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Zip | 53216-2264
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Country | US
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Telephone | 262-751-7496
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Fax |
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Authorized Official
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Title or Position | GENERAL PRACTICE
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Name | FARZANEH MASOOLTONDKAR
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Credential | M.D.
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Telephone | 262-751-7496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 52372-020
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License Number State | WI
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