Individual
DR. KHOSRO ADIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 SO PARK ST, MERITER HOSPITAL, MADISON, WI 53715
(608) 417-6259
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
21961
WI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
21961-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30266200
—
WI
Enumeration date
04/12/2006
Last updated
02/07/2013
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