Basic Information
| Provider Information | |||||||||
| NPI: | 1972672533 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDPOINT FAMILY CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W SILVER SPRING DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532094217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144619250 | ||||||||
| FaxNumber: | 4144613553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W SILVER SPRING DR | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532094217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144619250 | ||||||||
| FaxNumber: | 4144613553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | NAJEEB | ||||||||
| AuthorizedOfficialFirstName: | WALEED | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4144619250 | ||||||||
| IsSoleProprietor: | |||||||||
| 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 | 207RP1001X | 32123 | WI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 32885100 | 05 | WI | MEDICAID |