Provider Demographics
NPI:1427013499
Name:MOHIUDDIN, SYED G (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:G
Last Name:MOHIUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8500 W CAPITOL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1869
Mailing Address - Country:US
Mailing Address - Phone:414-431-5004
Mailing Address - Fax:414-431-2959
Practice Address - Street 1:8500 W CAPITOL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1869
Practice Address - Country:US
Practice Address - Phone:414-431-5004
Practice Address - Fax:414-431-2959
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI40863207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400130123Medicare PIN
WI006700240Medicare ID - Type Unspecified