Individual
DR. JAWAID QUDDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
6123 GREEN BAY ROAD, SUITE 120, KENOSHA, WI 53142-2927
(262) 764-4390
(262) 764-4396
Mailing address
6123 GREEN BAY ROAD, SUITE 120, KENOSHA, WI 53142-2927
(262) 764-4390
(262) 764-4396
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45606-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34414100
—
WI
Enumeration date
10/03/2005
Last updated
04/01/2011
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