=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588275036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABIFKA HEALTHCARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2020
-----------------------------------------------------
Last Update Date | 08/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8725 S WOOD CREEK DR
-----------------------------------------------------
City | OAK CREEK
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53154-7502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-238-1374
-----------------------------------------------------
Fax | 262-764-9644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2401 35TH STREET
-----------------------------------------------------
City | KENOSHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 126-294-5526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER /CEO/MD
-----------------------------------------------------
Name | DR. SYED N HASNAIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 414-238-1374
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------