Provider Demographics
NPI:1710951363
Name:KAMRANI, FARZAD (MD)
Entity Type:Individual
Prefix:MR
First Name:FARZAD
Middle Name:
Last Name:KAMRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S. 16TH STREET
Mailing Address - Street 2:S# 2007
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215
Mailing Address - Country:US
Mailing Address - Phone:414-645-7828
Mailing Address - Fax:414-645-7842
Practice Address - Street 1:3201 S. 16TH STREET
Practice Address - Street 2:S# 2007
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-645-7828
Practice Address - Fax:414-645-7842
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21446207RC0000X
WI21446-020207RC0000X
IL036-056984207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIKAMRAFAROtherMERCYCARE INSURANCE
WIP00849774CD3624OtherRR MEDICARE
WI000001643Medicare UPIN
WI541760694Medicare PIN
WIP00849774CD3624OtherRR MEDICARE