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NPI Code Detail

MEDICARE: DR. BAHAREH CHAGANI D.M.D.

MEDICARE: DR. BAHAREH CHAGANI D.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
1122300000XDentist6599-15WI

General Provider Information

NPI Number : 1871810473
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BAHAREH CHAGANI D.M.D.
Provider Business Mailing Address
First Line : 2801 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-4008
Country : US
Telephone Number : 414-288-7388
Fax Number :
Provider Business Practice Location Address
First Line : 1801 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2186
Country : US
Telephone Number : 617-595-1555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2010
Last Update Date : 03/29/2023

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