Moazam J Samdani MD SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19713 Issued in WI

Legal business name

MOAZAM J SAMDANI MD SC

Practice address

123 Hospital Dr
#214
Watertown, WI 53098

Phone

(920) 261-3333

Fax

(920) 261-6955

NPI assigned

Nov 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Moazam J Samdani, MD

Title

President

Phone

(920) 261-3333

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912078007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL DR",
            "address_2": "#214",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "53098",
            "telephone_number": "920-261-3333",
            "fax_number": "920-261-6955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL DR",
            "address_2": "#214",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "53098",
            "telephone_number": "920-261-3333",
            "fax_number": "920-261-6955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOAZAM J SAMDANI MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAMDANI",
        "authorized_official_first_name": "MOAZAM",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-261-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "19713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS HMO",
            "identifier": "1000279",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31092300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "80",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Kathlyn Miller, APRN
• Erin Miller, R.N.
• Susan A. Miller, RD,CD
• Laurie E Mitchell, P.T.
• Kendra L Moauro, PT, DPT
• Christina Molinaro, PA-C
• Melissa Monroe, LAT
• Samuel Moran
• Laura Morgan
• Nagel Neighborhood Health LLC

• Internal Medicine Physician in Watertown, WI
• Providers in Watertown, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.