Basic Information
| Provider Information | |||||||||
| NPI: | 1427330539 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEIGHT MANAGEMENT MEDICAL CENTER | ||||||||
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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: | 2426 N GRANDVIEW BLVD STE D | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531886905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627207060 | ||||||||
| FaxNumber: | 2624463760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | AHMAD | ||||||||
| AuthorizedOfficialFirstName: | FARID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2627207060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QB0002X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine |
No ID Information.