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General NPI Number Information
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NPI Number | 1396985636
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Entity Type | Organization
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Legal Business Name | AYAZ M. SAMADANI, MD, SC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 215 CORPORATE DR SUITE H
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City | BEAVER DAM
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State | WI
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Zip | 53916-3123
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Country | US
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Telephone | 920-887-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 215 CORPORATE DR SUITE H
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City | BEAVER DAM
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State | WI
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Zip | 53916-3123
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Country | US
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Telephone | 920-887-7731
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AYAZ M SAMADANI
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Credential | MD
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Telephone | 920-887-7731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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