Individual
TAREK JAZMATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
036151947
IL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
75569-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
036.151947
IL
390200000X
Student in an Organized Health Care Education/Training Program
BP10053652
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100176158
—
WI
Enumeration date
06/24/2015
Last updated
01/28/2026
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