Provider Demographics
NPI:1679351092
Name:ABDELGHANI, AHMAD Y (PA-C)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:Y
Last Name:ABDELGHANI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GOOLD ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4567
Mailing Address - Country:US
Mailing Address - Phone:262-622-6071
Mailing Address - Fax:
Practice Address - Street 1:800 GOOLD ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-4567
Practice Address - Country:US
Practice Address - Phone:262-622-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7630-23207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine