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General NPI Number Information
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NPI Number | 1407039548
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Entity Type | Organization
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Legal Business Name | ENDOCRINE CLINIC OF KENOSHA , S.C.
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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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 | 262-842-0420
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Fax | 262-842-0423
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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 | 262-842-0420
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Fax | 262-842-0423
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Authorized Official
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Title or Position | OWNER
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Name | DR. FARAH SALAHUDDIN
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Credential | M.D.
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Telephone | 262-842-0420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 45853020
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License Number State | WI
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