Individual
KEYVAN GHARABEIGHLOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2500 E ENTERPRISE AVE, UNIT C, APPLETON, WI 54913
(920) 739-5642
(920) 968-0259
Mailing address
2500 E ENTERPRISE AVE, UNIT C, APPLETON, WI 54913-4860
(920) 739-5642
(920) 968-0259
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
45650
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43506200
—
WI
Enumeration date
06/17/2006
Last updated
04/16/2008
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