Organization
MOAZAM J SAMDANI MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOAZAM J SAMDANI MD (PRESIDENT)
(920) 261-3333
Entity
Organization
Contact information
Practice address
123 HOSPITAL DR, #214, WATERTOWN, WI 53098
(920) 261-3333
(920) 261-6955
Mailing address
123 HOSPITAL DR, #214, WATERTOWN, WI 53098
(920) 261-3333
(920) 261-6955
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19713
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000279
PHYSICIANS PLUS HMO
WI
05
—
31092300
—
WI
01
—
80
DEAN HEALTH PLAN
WI
Enumeration date
11/13/2006
Last updated
08/22/2020
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