Provider Demographics
NPI:1427731736
Name:MUHAMMAD, PAUL C (SAC-IT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:C
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8266 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3606
Mailing Address - Country:US
Mailing Address - Phone:715-396-1675
Mailing Address - Fax:
Practice Address - Street 1:8266 N 50TH ST
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-3606
Practice Address - Country:US
Practice Address - Phone:715-396-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20274-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)