Individual
IMRAN AHMED MOINUDDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10400 75TH ST STE 305, KENOSHA, WI 53142-7884
(262) 948-7050
(262) 948-7271
Mailing address
10400 75TH ST STE 305, KENOSHA, WI 53142-7884
(262) 948-7050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
84843-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100334670
—
WI
Enumeration date
03/22/2022
Last updated
09/18/2025
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