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NPI Code Detail

MEDICARE: FARZANEH MASOOL TONDKAR M.D.

MEDICARE: FARZANEH MASOOL TONDKAR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician52372020WI
2207QA0401XAddiction Medicine (Family Medicine) Physician52372020WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689811861
Entity Type Code : Individual
Provider Name (Legal Business Name) : FARZANEH MASOOL TONDKAR M.D.
Provider Business Mailing Address
First Line : 10731 WEST FOREST HOME AVENUE
Second Line :
City : HALES CORNERS
State : WI
Zip : 53130-2555
Country : US
Telephone Number : 414-529-4600
Fax Number : 414-529-4689
Provider Business Practice Location Address
First Line : 10731 W FOREST HOME AVE
Second Line :
City : HALES CORNERS
State : WI
Zip : 53130-2555
Country : US
Telephone Number : 414-529-4600
Fax Number : 414-529-4689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2009
Last Update Date : 10/03/2023

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