Provider Demographics
NPI:1770597452
Name:MAGUID, AMANI A (MD)
Entity type:Individual
Prefix:
First Name:AMANI
Middle Name:A
Last Name:MAGUID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21675 E MORELAND BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3000
Mailing Address - Country:US
Mailing Address - Phone:262-657-5446
Mailing Address - Fax:262-395-4068
Practice Address - Street 1:21675 E MORELAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-657-5446
Practice Address - Fax:262-395-4068
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29206174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31423400Medicaid
WI1448Medicare ID - Type Unspecified
WI31423400Medicaid