Provider Demographics
NPI:1124020870
Name:MIAN, HAMAYUN SAEED (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMAYUN
Middle Name:SAEED
Last Name:MIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 S VAN BUREN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3538
Mailing Address - Country:US
Mailing Address - Phone:920-433-9400
Mailing Address - Fax:920-433-9409
Practice Address - Street 1:720 S VAN BUREN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3538
Practice Address - Country:US
Practice Address - Phone:920-433-9400
Practice Address - Fax:920-433-9409
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46435208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34481800Medicaid
WI1124020870Medicaid
MI3402210611OtherBLUE CROSS MI
MI4743917Medicaid
WI07235-0002Medicare ID - Type Unspecified
MI3402210611OtherBLUE CROSS MI