Tariq Elmadawy

Primary specialty

DentistTaxonomy code 122300000X

License

2901601681 Issued in MI

Practice address

1551 Park PL Ste 300
Green Bay, WI 54304-1969

Phone

(920) 332-6644

NPI assigned

Jun 29, 2023

Last updated

Jan 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1164109336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 MARINA CIR UNIT 502",
            "city": "ASHWAUBENON",
            "state": "WI",
            "postal_code": "543044877",
            "telephone_number": "734-502-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PARK PL STE 300",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543041969",
            "telephone_number": "920-332-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELMADAWY",
        "first_name": "TARIQ",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-29",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001237-15",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Ellis, DPT
• Charles Lee Ellis, DDS, MD
• Stephanie Marie Ellman, ARNP
• James Leigh Elm, O.D.
• Teresa Elm
• Unknown Elsa Kurian, DDS
• Muna Elsiddig, MD
• Embodied-Wellbeing Limited Liability Company
• Embodied-Welllbeing
• Tucker Anthony Emerson, D.C.

• Dentist in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.