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Organization
AYAZ M. SAMADANI, MD, SC
Active
Organization
AYAZ M. SAMADANI, MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYAZ M SAMADANI MD (OWNER)
(920) 887-7731
Entity
Organization
Contact information
Practice address
215 CORPORATE DR, SUITE H, BEAVER DAM, WI 53916-3123
(920) 887-7731
Mailing address
215 CORPORATE DR, SUITE H, BEAVER DAM, WI 53916-3123
(920) 887-7731
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NULL
291U00000X
Clinical Medical Laboratory
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P61
DEAN HEALTH INSURANCE
WI
Enumeration date
02/26/2009
Last updated
07/14/2014
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