Individual
DR. AHMAD S KHRAISAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4448 W LOOMIS RD, GREENFIELD, WI 53220-4800
(414) 817-0784
(414) 817-0787
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
43201
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100012862
—
WI
05
—
1750375143
—
WI
Enumeration date
08/31/2005
Last updated
12/10/2024
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