NPIMap

Organization Active NPI

Independent Physicians of Wisconsin, LLC

  • Internal Medicine Physician
  • Milwaukee, WI
National Provider Identifier
1871975920
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INDEPENDENT PHYSICIANS OF WISCONSIN, LLC
Practice address
5434 W Capitol Dr Ste 3
Milwaukee, WI 53216-2298
Phone
(414) 875-0505
NPI assigned
Jun 25, 2015
Last updated
May 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Authorized official

Name
Mohammad Qasim Khan, MDNPI 1104892868
Title
Managing Member
Phone
(414) 875-0505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X
Sleep Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RS0012X

Addresses

Primary practice location

5434 W Capitol Dr Ste 3
Milwaukee, WI 53216-2298

Mailing address

5434 W Capitol Dr Ste 3
Milwaukee, WI 53216-2298
Phone (414) 875-0505

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151016001548 WI Part B Supplier - Clinic/Group Practice 3274842034 Receives reassigned benefits from 50 practitioners

National Provider Directory

National Provider Directory

Locations

W178N9912 Rivercrest Dr
Ste 105
Germantown, WI 53022
Phone (262) 682-8810

4931 S 27th St
Ste 100
Greenfield, WI 53221
Phone (414) 281-9533

4931 S 27th St
Ste 400B
Greenfield, WI 53221
Phone (414) 376-9701

6123 Green Bay Rd
Ste 260
Kenosha, WI 53142
Phone (262) 731-0077

6125 Green Bay Rd
Kenosha, WI 53142
Phone (262) 564-8636

W178N9201 Water Tower Pl
Ste 200
Menomonee Falls, WI 53051
Phone (262) 355-8010

1249 W Liebau Rd
Ste 201
Mequon, WI 53092
Phone (262) 510-0300

2500 W Layton Ave
Ste 130
Milwaukee, WI 53221
Phone (414) 281-1944

2500 W Layton Ave
Ste 280
Milwaukee, WI 53221
Phone (414) 306-6500

4931 S 27th St
Ste 400
Milwaukee, WI 53221
Phone (414) 672-7200

5434 W Capitol Dr
Ste 3
Milwaukee, WI 53216
Phone (414) 217-1229

6111 N Teutonia Ave
Milwaukee, WI 53209
Phone (262) 899-9245

2603 W Rawson Ave
Ste 108
Oak Creek, WI 53154
Phone (414) 431-6990

2603 W Rawson Ave
Ste 113
Oak Creek, WI 53154
Phone (414) 431-6900

N28W23000 Roundy Dr
Ste 202
Pewaukee, WI 53072
Phone (262) 565-5090

10460 W Innovation Dr
Ste 102
Wauwatosa, WI 53226
Phone (414) 563-1230

2675 N Mayfair Rd
Ste 308
Wauwatosa, WI 53226

Ownership & related parties

Subparts reporting this organization as parent 7

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1871975920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5434 W CAPITOL DR STE 3",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532162298",
            "telephone_number": "414-875-0505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5434 W CAPITOL DR STE 3",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532162298",
            "telephone_number": "414-875-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICIANS OF WISCONSIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "QASIM",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "414-875-0505",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.