Provider Demographics
NPI:1285968040
Name:F TONDKAR LLC
Entity type:Organization
Organization Name:F TONDKAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:FARZANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOLTONDKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-751-7496
Mailing Address - Street 1:5310 W CAPITOL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2264
Mailing Address - Country:US
Mailing Address - Phone:262-751-7496
Mailing Address - Fax:
Practice Address - Street 1:5310 W. CAPITAL DR. STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2264
Practice Address - Country:US
Practice Address - Phone:262-751-7496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52372-020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689811861Medicare NSC