Provider Demographics
NPI:1710184080
Name:KHALID, SYEDA QUDSIA-FATIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:SYEDA
Middle Name:QUDSIA-FATIMA
Last Name:KHALID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SYEDA
Other - Middle Name:QUDSIA
Other - Last Name:FATIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3100 WILLIAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4505
Mailing Address - Country:US
Mailing Address - Phone:504-443-1744
Mailing Address - Fax:504-684-1375
Practice Address - Street 1:8375 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-8344
Practice Address - Country:US
Practice Address - Phone:414-764-5726
Practice Address - Fax:414-764-6954
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64003208000000X
MI4301088657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1710184080Medicaid