Individual
IMTIAZ MOHAMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11040 N STATE ROAD 77, HAYWARD, WI 54843-3606
(715) 934-4321
Mailing address
11040 N STATE ROAD 77, HAYWARD, WI 54843-3606
(715) 934-4321
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
41063
WI
207RG0100X
Gastroenterology Physician
Primary
56386
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396796884
—
MI
05
—
1396796884
—
MN
05
—
1396796884
—
WI
05
—
32584300
—
WI
Enumeration date
05/12/2006
Last updated
06/12/2020
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