Basic Information
| Provider Information | |||||||||
| NPI: | 1821027772 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA MED CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1232 EAST AVE N | ||||||||
| Address2: | |||||||||
| City: | ONALASKA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546509043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087795817 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 E VETERANS ST | ||||||||
| Address2: | |||||||||
| City: | TOMAH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546603105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083723971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BILAL | ||||||||
| AuthorizedOfficialFirstName: | AHMAD | ||||||||
| AuthorizedOfficialMiddleName: | - | ||||||||
| AuthorizedOfficialTitleorPosition: | STAFF PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 6083723971 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 47362 | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.