Individual
MISS TAAHA S RAFI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(262) 948-5600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125073106
IL
207Q00000X
Family Medicine Physician
Primary
77249
WI
207RS0012X
Sleep Medicine (Internal Medicine) Physician
77249
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100209613
—
WI
Enumeration date
06/21/2018
Last updated
10/25/2023
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