Provider Demographics
NPI:1831451483
Name:AMANI A MAGUID MD SC
Entity type:Organization
Organization Name:AMANI A MAGUID MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGUID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-657-5446
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty