Provider Demographics
NPI:1396592440
Name:AMIN, FEISAL ABDULRAHMAN
Entity type:Individual
Prefix:
First Name:FEISAL
Middle Name:ABDULRAHMAN
Last Name:AMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1084
Mailing Address - Country:US
Mailing Address - Phone:612-417-4888
Mailing Address - Fax:
Practice Address - Street 1:980 BRUCE ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1084
Practice Address - Country:US
Practice Address - Phone:612-417-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0019907310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility