Provider Demographics
NPI:1013026285
Name:CARDIOVASCULAR MEDICINE OF WAUKESHA, S.C.
Entity Type:Organization
Organization Name:CARDIOVASCULAR MEDICINE OF WAUKESHA, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:AHMAD
Authorized Official - Last Name:KATIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-521-2101
Mailing Address - Street 1:721 AMERICAN AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5071
Mailing Address - Country:US
Mailing Address - Phone:262-521-2101
Mailing Address - Fax:262-521-1482
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-521-2101
Practice Address - Fax:262-521-1482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32801700Medicare ID - Type Unspecified