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General NPI Number Information
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NPI Number | 1417498718
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Entity Type | Organization
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Legal Business Name | BADGER CARE LLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 210 N MAIN ST
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City | DEFOREST
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State | WI
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Zip | 53532-1163
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Country | US
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Telephone | 608-842-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N MAIN ST STE 103
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City | DEFOREST
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State | WI
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Zip | 53532-1163
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Country | US
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Telephone | 608-842-2660
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SALAM SYED
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Credential | MD
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Telephone | 608-842-2660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53833
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License Number State | WI
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