Provider Demographics
NPI:1851910673
Name:JEELANI, WAJIHA (MBBS)
Entity Type:Individual
Prefix:
First Name:WAJIHA
Middle Name:
Last Name:JEELANI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:WAJIHA
Other - Middle Name:
Other - Last Name:JEELANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS
Mailing Address - Street 1:5433 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1382
Mailing Address - Country:US
Mailing Address - Phone:414-277-8909
Mailing Address - Fax:414-277-8939
Practice Address - Street 1:5433 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1382
Practice Address - Country:US
Practice Address - Phone:414-277-8909
Practice Address - Fax:414-277-8939
Is Sole Proprietor?:No
Enumeration Date:2020-04-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81834208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty