Provider Demographics
NPI:1760677181
Name:ARNAVAZ DUA MD SC
Entity Type:Organization
Organization Name:ARNAVAZ DUA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNAVAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-542-9531
Mailing Address - Street 1:1111 DELAFIELD ST
Mailing Address - Street 2:MORELAND MEDICAL BUILDING STE 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 BUILDING STE 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:262-542-6461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty