Individual
AYAZ M SAMADANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
215 CORPORATE DR, SUITE H, BEAVER DAM, WI 53916-3123
(920) 887-7731
Mailing address
215 CORPORATE DR, SUITE H, BEAVER DAM, WI 53916-3123
(920) 887-7731
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
20554-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001259
PHYSICIANS PLUS
WI
01
—
17209
DEAN HEALTH INSURANCE
WI
05
—
31059600
—
WI
Enumeration date
05/11/2006
Last updated
07/14/2014
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