Provider Demographics
NPI:1619979515
Name:DUA, ARNAVAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNAVAZ
Middle Name:
Last Name:DUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ARNAVAZ
Other - Middle Name:
Other - Last Name:DUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:MORELAND MEDICAL BLDG SUITE 203
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3417
Mailing Address - Country:US
Mailing Address - Phone:262-542-9531
Mailing Address - Fax:262-542-6461
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:MORELAND MEDICAL BLDG SUITE 203
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-542-9531
Practice Address - Fax:262-542-9531
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35307207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32581700Medicaid
68054Medicare ID - Type Unspecified
G97652Medicare UPIN