Mustafa Syed Azimuddin, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

73923 Issued in WI

Practice address

4328 Old Green Bay Rd
Mount Pleasant, WI 53403-9489

Phone

(262) 687-7606

NPI assigned

Jun 1, 2017

Last updated

Jan 3, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ascension Medical Group-Southeast Wisconsin IncGroup PAC ID 8628980943, 551 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension at Home Home health agency, Milwaukee, WI, CCN 527187
• Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ascension Medical Group-Southeast Wisconsin Inc

  dba Ascension Medical Group

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Ascension All Saints Hospital, Inc

  dba Ascension Rx 1101

  • Community/Retail Pharmacy
  • Mount Pleasant, WI
  • NPI 1164522132
  NPD (past)
• Ascension All Saints Hospital, Inc

  dba Ascension All Saints Hospital

  • Rehabilitation Hospital Unit
  • Racine, WI
  • NPI 1417966540
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ascension All Saints Hospital, Inc

  dba Ascension All Saints Hospital

  • General Acute Care Hospital
  • Racine, WI
  • NPI 1639123284
  Care Compare affiliation
• Wheaton Franciscan Home Health & Hospice, LLC

  dba Ascension at Home

  • Home Health Agency
  • Milwaukee, WI
  • NPI 1003820861
  Care Compare affiliation

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1366970576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4328 OLD GREEN BAY RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039489",
            "telephone_number": "262-687-7606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4328 OLD GREEN BAY RD",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534039489",
            "telephone_number": "262-687-7606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Community Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "LA Grange",
            "state": "IL",
            "postal_code": "605252659",
            "country_code": "US",
            "telephone_number": "708-245-8900",
            "fax_number": "708-245-5777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AZIMUDDIN",
        "first_name": "MUSTAFA",
        "middle_name": "SYED",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125070421",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "73923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aurora Pharmacy Inc (Aurora Pharmacy)
• Aurora Pharmacy Inc. (Aurora Pharmacy #1433)
• Heatherly D Awad, LPN
• Axis BH LLC
• Sameh E Azab, DDS
• Joshua Raymond Babcock, PA-C
• Badger Care LLC
• William Paul Bake, D.O.
• Kaylee Nicole Balchitis
• Alicia S Balistreri

• Family Medicine Physician in Mount Pleasant, WI
• Providers in Mount Pleasant, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.