Provider Demographics
NPI:1538368949
Name:FARZAD KAMRANI,MD.SC.
Entity type:Organization
Organization Name:FARZAD KAMRANI,MD.SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-645-7828
Mailing Address - Street 1:3201 S 16TH ST
Mailing Address - Street 2:S# 2007
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4537
Mailing Address - Country:US
Mailing Address - Phone:414-645-7828
Mailing Address - Fax:414-645-7842
Practice Address - Street 1:3201 S 16TH ST
Practice Address - Street 2:S# 2007
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4537
Practice Address - Country:US
Practice Address - Phone:414-645-7828
Practice Address - Fax:414-645-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21446261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1463Medicare PIN