Provider Demographics
NPI:1356321970
Name:LAKHDHIR, AMIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIN
Middle Name:A
Last Name:LAKHDHIR
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 1:933 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1730
Mailing Address - Country:US
Mailing Address - Phone:920-748-0430
Mailing Address - Fax:920-748-0533
Practice Address - Street 1:1010 N WASHINGTON ST.
Practice Address - Street 2:MERCY MALL CLINIC
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1561
Practice Address - Country:US
Practice Address - Phone:608-741-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44084-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34180200Medicaid
WI0029Medicare ID - Type Unspecified
WI34180200Medicaid