Provider Demographics
NPI:1174599500
Name:MUZAFFAR, KAMAL S (MD)
Entity type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:S
Last Name:MUZAFFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-1732
Mailing Address - Country:US
Mailing Address - Phone:262-743-1122
Mailing Address - Fax:262-743-1582
Practice Address - Street 1:100 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1732
Practice Address - Country:US
Practice Address - Phone:262-743-1122
Practice Address - Fax:262-743-1582
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43819-020207P00000X
WI43819-20208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34151600Medicaid
WI34151600Medicaid
WI000001473Medicare PIN
WIH52036Medicare UPIN
WI34151600Medicaid
WI$$$$$$$$$003OtherBLUE SHIELD