Basic Information
| Provider Information | |||||||||
| NPI: | 1235443615 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISITING MEDICAL DOCTORS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VMDS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | N85W18181 TYLER DR | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530512535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622551040 | ||||||||
| FaxNumber: | 2622554090 | ||||||||
| Practice Location | |||||||||
| Address1: | 7071 S 13TH ST | ||||||||
| Address2: | STE#103 | ||||||||
| City: | OAK CREEK | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531541466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147646080 | ||||||||
| FaxNumber: | 4147646091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 01/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | AHMAD | ||||||||
| AuthorizedOfficialFirstName: | FARID | ||||||||
| AuthorizedOfficialMiddleName: | AREF | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4142556141 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.