Provider Demographics
NPI:1548467863
Name:ABDUL G. DURRANI MD SC
Entity type:Organization
Organization Name:ABDUL G. DURRANI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DURRANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-658-3994
Mailing Address - Street 1:6127 GREEN BAY RD STE 600
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2930
Mailing Address - Country:US
Mailing Address - Phone:262-658-3994
Mailing Address - Fax:262-658-0300
Practice Address - Street 1:6127 GREEN BAY RD STE 600
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2930
Practice Address - Country:US
Practice Address - Phone:262-658-3994
Practice Address - Fax:262-658-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32086900Medicaid
WIF94374Medicare UPIN
WI32086900Medicaid