Basic Information
| Provider Information | |||||||||
| NPI: | 1194175042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDULMONIEM | ||||||||
| FirstName: | ABDULMONIEM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | W3985 COUNTY ROAD NN | ||||||||
| Address2: | |||||||||
| City: | ELKHORN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531214337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627412000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | W3985 COUNTY ROAD NN | ||||||||
| Address2: | |||||||||
| City: | ELKHORN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531214337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627412000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 08/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101266353 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 75558 | WI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100170895 | 05 | WI | MEDICAID |