Provider Demographics
NPI:1083744486
Name:BADRUDDUJA, MUSTAFA SYED (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:SYED
Last Name:BADRUDDUJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:SUITE 3050
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-654-7002
Mailing Address - Fax:262-654-6822
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:SUITE 3050
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-654-7002
Practice Address - Fax:262-654-6822
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087678208600000X
WI51809208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery