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130 Warren St Ste 132 Beaver Dam WI 53916 | |
| (920) 887-7181 | |
| (920) 887-6833 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 130 Warren St Ste 132, Beaver Dam, Wisconsin |
| Authorized Official Name and Position | Gordon T Edwards (CFO/COO/AO) |
| Authorized Official Contact | 7153875823 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1000 N Oak Ave Attn: Provider Enrollment Services/wwp Marshfield WI 54449-5703 Ph: (715) 389-0660 | 130 Warren St Ste 132 Beaver Dam WI 53916 Ph: (920) 887-7181 |
| NPI Number | 1538491998 |
|---|---|
| Provider Enumeration Date | 02/09/2010 |
| Last Update Date | 03/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538491998 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 851-800 (Wisconsin) | Primary |
Ayaz Samandani Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr, Suite H, Beaver Dam, WI 53916 Phone: 920-887-7731 Fax: 920-887-3201 | |
Ayaz M. Samadani, Md, Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr, Suite H, Beaver Dam, WI 53916 Phone: 920-887-7731 | |
Quad/med, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Corporate Dr Ste A, Beaver Dam, WI 53916 Phone: 414-566-4000 | |
Victor W. Caceres, M.d.,s.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 919 S. University Avenue, Beaver Dam, WI 53916 Phone: 920-885-9238 Fax: 920-885-4405 |