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General NPI Number Information
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NPI Number | 1528101433
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Entity Type | Organization
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Legal Business Name | JANDALI SURGICAL ASSOCIATES, S.C.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 9555 76TH ST STE 4880
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1984
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Country | US
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Telephone | 262-748-1001
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Fax | 262-748-1020
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Provider Business Mailing Address
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Address Line | 9555 76TH ST STE 4880
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1984
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Country | US
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Telephone | 262-748-1001
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Fax | 262-748-1020
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Authorized Official
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Title or Position | OWNER/MEDICAL DOCTOR
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Name | MAJED JANDALI
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Credential | M.D.
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Telephone | 262-748-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 34339
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License Number State | WI
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