MEDICARE: AYMEN M KHOGALI MD

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
1	207R00000X	Internal Medicine Physician	51365	WI
2	208M00000X	Hospitalist Physician	51365	WI

General Provider Information

NPI Number	:	1689851412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYMEN M KHOGALI MD

Provider Business Mailing Address
First Line	:	945 N 12TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1305
Country	:	US
Telephone Number	:	414-219-5199
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 N 12TH ST
Second Line	:	AURORA SINAI MEDICAL CENTER
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-0342
Country	:	US
Telephone Number	:	414-219-2000
Fax Number	:	414-219-4539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	07/02/2019

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