Provider Demographics
NPI:1578850699
Name:BADGER CARE LLC
Entity Type:Organization
Organization Name:BADGER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAM
Authorized Official - Middle Name:U
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-276-9281
Mailing Address - Street 1:9009 N WHITE OAK LN
Mailing Address - Street 2:#226
Mailing Address - City:BAYSIDE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-6201
Mailing Address - Country:US
Mailing Address - Phone:347-276-9281
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:1300 S GREEN BAY RD
Practice Address - Street 2:#205
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4469
Practice Address - Country:US
Practice Address - Phone:347-276-9281
Practice Address - Fax:414-247-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53833208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty