Provider Demographics
NPI:1841510492
Name:VAIDY, NISHANT K (MD)
Entity type:Individual
Prefix:
First Name:NISHANT
Middle Name:K
Last Name:VAIDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-328-8777
Mailing Address - Fax:414-328-8110
Practice Address - Street 1:2424 S 90TH ST FL 2
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2455
Practice Address - Country:US
Practice Address - Phone:414-328-8777
Practice Address - Fax:414-328-8110
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY274998207R00000X
WI22500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100206707Medicaid