=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578474730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KHADIJA'S KOZY KORNER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8320 W LISBON AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53222-3866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-808-0081
-----------------------------------------------------
Fax | 262-364-3319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8320 W LISBON AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53222-3866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-808-0081
-----------------------------------------------------
Fax | 262-364-3319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RAQIBA MALIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-301-0020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------