Mohamed, Imtiaz

Mohamed, Imtiaz is an individual health care provider with primary practice located at 11040 N State Road 77 , Hayward WI 54843-3606. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Mohamed, Imtiaz can be contacted via phone (715) 934-4321.

Contact Information

Primary practice address
11040 N State Road 77 Hayward WI 54843-3606
Phone: (715) 934-4321
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 41063 Wisconsin
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 56386 Minnesota

Profile Details

NPI number 1396796884
LBN Legal business name Mohamed, Imtiaz
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Jun 12th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396796884 NPPES
Michigan MEDICAID 1396796884
Michigan MEDICAID 1396796884
Michigan MEDICAID 1396796884
Michigan MEDICAID 32584300

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