# INDEPENDENT PHYSICIANS OF WISCONSIN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871975920
- **Authorized official:** MOHAMMAD QASIM KHAN MD (MANAGING MEMBER)
- **Authorized official phone:** (414) 875-0505

## Contact information

- **Practice address:** 5434 W CAPITOL DR STE 3, MILWAUKEE, WI 53216-2298
- **Practice address phone:** (414) 875-0505
- **Mailing address:** 5434 W CAPITOL DR STE 3, MILWAUKEE, WI 53216-2298
- **Mailing address phone:** (414) 875-0505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RS0012X | Sleep Medicine (Internal Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 06/25/2015
- **Last updated:** 05/06/2021