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General NPI Number Information
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NPI Number | 1518291376
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Entity Type | Organization
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Legal Business Name | FAMILY PEDIATRICS, INC.
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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 | 3601 30TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-1695
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Country | US
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Telephone | 262-564-0611
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 30TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-1695
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Country | US
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Telephone | 262-564-0611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZAIGHAM ULLAH TAHIR
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Credential | DO
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Telephone | 262-564-0611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036.102772
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 45299-021
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License Number State | WI
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