Provider Demographics
NPI:1952442394
Name:VALLEY NEUROLOGY CLINIC SC
Entity Type:Organization
Organization Name:VALLEY NEUROLOGY CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-236-3201
Mailing Address - Street 1:555 S WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904
Mailing Address - Country:US
Mailing Address - Phone:920-236-3201
Mailing Address - Fax:920-236-3203
Practice Address - Street 1:555 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904
Practice Address - Country:US
Practice Address - Phone:920-236-3201
Practice Address - Fax:920-236-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI230692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21360900Medicaid
WI21360900Medicaid