Provider Demographics
NPI:1689670754
Name:NIAZI, IMRAN K (MD)
Entity type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:K
Last Name:NIAZI
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 1:2901 W KK RIVER PKWY
Mailing Address - Street 2:STE 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-645-6070
Mailing Address - Fax:414-645-6354
Practice Address - Street 1:2901 W KK RIVER PKWY
Practice Address - Street 2:STE 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-645-6070
Practice Address - Fax:414-645-6354
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26591207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30779500Medicaid
WI30779500Medicaid
WIB55361Medicare UPIN