Provider Demographics
NPI:1306833686
Name:DURRANI, ABDUL GHAFFAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:GHAFFAR
Last Name:DURRANI
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 1:4824 GREEN BAY ROAD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1789
Mailing Address - Country:US
Mailing Address - Phone:262-658-3994
Mailing Address - Fax:262-658-0300
Practice Address - Street 1:4824 GREEN BAY ROAD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1789
Practice Address - Country:US
Practice Address - Phone:262-658-3994
Practice Address - Fax:262-658-0300
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34697-020207Q00000X
WI34697207Q00000X
WI34697-20208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32086900Medicaid
WIF94374Medicare UPIN