Provider Demographics
NPI:1366529901
Name:HAFFAR, AHMAD Y (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:Y
Last Name:HAFFAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1043
Mailing Address - Country:US
Mailing Address - Phone:888-724-6377
Mailing Address - Fax:715-251-1681
Practice Address - Street 1:3475 OMRO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7125
Practice Address - Country:US
Practice Address - Phone:920-236-0991
Practice Address - Fax:920-236-0993
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI230692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21300900Medicaid
WI30348500Medicaid
WI71465Medicare ID - Type Unspecified
WI71482Medicare ID - Type Unspecified
WI21300900Medicaid
WI600560006Medicare PIN