Individual
MR. MUHAMMED R AL-FAWAKHIRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9201
(262) 329-3450
Mailing address
975 PORT WASHINGTON RD, GRAFTON, WI 53024-9201
(262) 329-3450
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2010-01667
NC
207R00000X
Internal Medicine Physician
35084303A
OH
207R00000X
Internal Medicine Physician
Primary
54875-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000332478
ANTHEM
—
01
—
0409665
UNITED HEALTHCARE
—
05
—
2478859
—
OH
01
—
341783789032
CARE SOURCE
—
01
—
7832578
AETNA
—
01
—
F84303
SUMMACARE APEX
—
Enumeration date
02/23/2006
Last updated
04/07/2011
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