Organization
ENDOCRINE CLINIC OF KENOSHA , S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FARAH SALAHUDDIN M.D. (OWNER)
(262) 842-0420
Entity
Organization
Contact information
Practice address
3535 30TH AVE, SUITE 101B, KENOSHA, WI 53144-1632
(262) 842-0420
(262) 842-0423
Mailing address
3535 30TH AVE, SUITE 101B, KENOSHA, WI 53144-1632
(262) 842-0420
(262) 842-0423
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
45853020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34438700
—
WI
Enumeration date
12/12/2007
Last updated
12/12/2007
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