Provider Demographics
NPI:1356506794
Name:GARDEZI, ALI IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:IBRAHIM
Last Name:GARDEZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3034 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3125
Practice Address - Country:US
Practice Address - Phone:608-270-5656
Practice Address - Fax:608-270-5602
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI61896207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program