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General NPI Number Information
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NPI Number | 1578793949
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Entity Type | Individual
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Provider Name | NIKHATH IRFANA M.D
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1220 DEWEY AVE
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City | WAUWATOSA
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State | WI
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Zip | 53213-2504
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Country | US
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Telephone | 414-454-6753
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 55467-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 55467
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036162319
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License Number State | IL
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