Provider Demographics
NPI:1972580140
Name:AAFREEN, TAHMINA (MD)
Entity type:Individual
Prefix:
First Name:TAHMINA
Middle Name:
Last Name:AAFREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3304
Mailing Address - Country:US
Mailing Address - Phone:920-262-4825
Mailing Address - Fax:920-206-3025
Practice Address - Street 1:128 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3304
Practice Address - Country:US
Practice Address - Phone:920-262-4825
Practice Address - Fax:920-206-3025
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1972580140Medicaid
H29231Medicare UPIN
WI1972580140Medicaid